TENET HEALTHCARE CORP, 10-K filed on 2/18/2022
Annual Report
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Cover Page - USD ($)
$ in Billions
 12 Months Ended
Dec. 31, 2021
Jan. 31, 2022
Jun. 30, 2021
Entity Information [Line Items]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2021    
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    
Entity Shell Company false    
Entity Public Float     $ 5.4
Entity Common Stock, Shares Outstanding   107,416,704  
Documents Incorporated by Reference Portions of the Registrant’s definitive proxy statement for the 2022 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 2021    
Document Fiscal Period Focus FY    
Common Stock | New York Stock Exchange      
Entity Information [Line Items]      
Title of 12(b) Security Common stock,    
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, 2021
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, 2021
Dec. 31, 2020
Current assets:    
Cash and cash equivalents $ 2,364 $ 2,446
Accounts receivable 2,770 2,690
Inventories of supplies, at cost 384 368
Assets held for sale 0 140
Other current assets 1,557 1,503
Total current assets  7,075 7,147
Investments and other assets 3,254 2,534
Deferred income taxes 65 325
Property and equipment, at cost, less accumulated depreciation and amortization ($5,960 at December 31, 2021 and $6,043 at December 31, 2020) 6,427 6,692
Goodwill 9,261 8,808
Other intangible assets, at cost, less accumulated amortization ($1,374 at December 31, 2021 and $1,284 at December 31, 2020) 1,497 1,600
Total assets  27,579 27,106
Current liabilities:    
Current portion of long-term debt 135 145
Accounts payable 1,300 1,207
Accrued compensation and benefits 896 942
Professional and general liability reserves 254 243
Accrued interest payable 203 248
Liabilities held for sale 0 70
Contract liabilities 959 659
Other current liabilities 1,362 1,333
Total current liabilities  5,109 4,847
Long-term debt, net of current portion 15,511 15,574
Professional and general liability reserves 791 735
Defined benefit plan obligations 421 497
Deferred income taxes 36 29
Contract liabilities – long-term 15 918
Other long-term liabilities 1,439 1,617
Total liabilities  23,322 24,217
Commitments and contingencies
Redeemable noncontrolling interests in equity of consolidated subsidiaries 2,203 1,952
Shareholders’ equity:    
Common stock, $0.05 par value; authorized 262,500,000 shares; 155,520,691 shares issued at December 31, 2021 and 154,407,524 shares issued at December 31, 2020 8 7
Additional paid-in capital 4,877 4,844
Accumulated other comprehensive loss (233) (281)
Accumulated deficit (1,214) (2,128)
Common stock in treasury, at cost, 48,331,649 shares at December 31, 2021 and 48,337,947 shares at December 31, 2020 (2,410) (2,414)
Total shareholders’ equity 1,028 28
Noncontrolling interests  1,026 909
Total equity  2,054 937
Total liabilities and equity  $ 27,579 $ 27,106
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CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Statement of Financial Position [Abstract]    
Property and equipment, accumulated depreciation and amortization $ 5,960 $ 6,043
Other intangible assets, accumulated amortization $ 1,374 $ 1,284
Common stock, par value (in dollars per share) $ 0.05 $ 0.05
Common stock, number of shares authorized (in shares) 262,500,000 262,500,000
Common stock, number of shares issued (in shares) 155,520,691 154,407,524
Common stock, number of shares held in treasury (in shares) 48,331,649 48,337,947
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CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)
shares in Thousands
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Income Statement [Abstract]      
Net operating revenues  $ 19,485,000,000 $ 17,640,000,000 $ 18,479,000,000
Grant income 191,000,000 882,000,000 0
Equity in earnings of unconsolidated affiliates 218,000,000 169,000,000 175,000,000
Operating expenses:      
Salaries, wages and benefits 8,878,000,000 8,418,000,000 8,698,000,000
Supplies 3,328,000,000 2,982,000,000 3,057,000,000
Other operating expenses, net 4,206,000,000 4,125,000,000 4,171,000,000
Depreciation and amortization 855,000,000 857,000,000 850,000,000
Impairment and restructuring charges, and acquisition-related costs 85,000,000 290,000,000 185,000,000
Litigation and investigation costs 116,000,000 44,000,000 141,000,000
Net losses (gains) on sales, consolidation and deconsolidation of facilities (445,000,000) (14,000,000) 15,000,000
Operating income 2,871,000,000 1,989,000,000 1,537,000,000
Interest expense (923,000,000) (1,003,000,000) (985,000,000)
Other non-operating income (expense), net 14,000,000 1,000,000 (5,000,000)
Loss from early extinguishment of debt (74,000,000) (316,000,000) (227,000,000)
Income from continuing operations, before income taxes 1,888,000,000 671,000,000 320,000,000
Income tax benefit (expense) (411,000,000) 97,000,000 (160,000,000)
Income from continuing operations, before discontinued operations 1,477,000,000 768,000,000 160,000,000
Discontinued operations:      
Income (loss) from operations (1,000,000) 0 15,000,000
Income tax expense 0 0 (4,000,000)
Income (loss) from discontinued operations (1,000,000) 0 11,000,000
Net income 1,476,000,000 768,000,000 171,000,000
Less: Net income available to noncontrolling interests 562,000,000 369,000,000 386,000,000
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders 914,000,000 399,000,000 (215,000,000)
Amounts available (attributable) to Tenet Healthcare Corporation common shareholders      
Income (loss) from continuing operations, net of tax 915,000,000 399,000,000 (226,000,000)
Income (loss) from discontinued operations, net of tax (1,000,000) 0 11,000,000
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders $ 914,000,000 $ 399,000,000 $ (215,000,000)
Basic      
Continuing operations (in dollars per share) $ 8.56 $ 3.80 $ (2.19)
Discontinued operations (in dollars per share) (0.01) 0 0.11
Total earnings (loss) per share, Basic (in dollars per share) 8.55 3.80 (2.08)
Diluted      
Continuing operations (in dollars per share) 8.43 3.75 (2.19)
Discontinued operations (in dollars per share) (0.01) 0 0.11
Total earnings (loss) per share, Diluted (in dollars per share) $ 8.42 $ 3.75 $ (2.08)
Weighted average shares and dilutive securities outstanding (in thousands):      
Basic (in shares) 106,833 105,010 103,398
Diluted (in shares) 108,571 106,263 103,398
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CONSOLIDATED STATEMENTS OF OTHER COMPREHENSIVE INCOME (LOSS) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Statement of Comprehensive Income [Abstract]      
Net income $ 1,476 $ 768 $ 171
Other comprehensive income (loss):      
Adjustments for defined benefit plans 50 (41) (52)
Amortization of net actuarial loss included in other non-operating income (expense), net 11 9 10
Unrealized gain on debt securities held as available-for-sale 0 1 0
Foreign currency translation adjustments and other 1 0 0
Other comprehensive income (loss) before income taxes 62 (31) (42)
Income tax benefit (expense) related to items of other comprehensive income (loss) (14) 7 8
Total other comprehensive income (loss), net of tax 48 (24) (34)
Comprehensive net income 1,524 744 137
Less: Comprehensive income to noncontrolling interests 562 369 386
Comprehensive income available (loss attributable) to Tenet Healthcare Corporation common shareholders $ 962 $ 375 $ (249)
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CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY - USD ($)
shares in Thousands, $ in Millions
Total
Cumulative Effect, Period of Adoption, Adjustment
Common Stock
Additional Paid-in Capital
Accumulated Other Comprehensive Loss
Accumulated Deficit
Accumulated Deficit
Cumulative Effect, Period of Adoption, Adjustment
Treasury Stock
Noncontrolling Interests
Beginning balance (in shares) at Dec. 31, 2018     102,537            
Beginning balance at Dec. 31, 2018 $ 624 $ 1 $ 7 $ 4,747 $ (223) $ (2,299) $ 1 $ (2,414) $ 806
Changes in Shareholders' Equity                  
Net income (loss) (21)         (215)     194
Distributions paid to noncontrolling interests (162)               (162)
Other comprehensive income (loss) (34)       (34)        
Accretion of redeemable noncontrolling interests (18)     (18)          
Purchases (sales) of businesses and noncontrolling interests, net 9     (7)         16
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)     1,660            
Stock-based compensation expense, tax benefit and issuance of common stock 38     38          
Ending balance (in shares) at Dec. 31, 2019     104,197            
Ending balance at Dec. 31, 2019 437 $ (14) $ 7 4,760 (257) (2,513) $ (14) (2,414) 854
Changes in Shareholders' Equity                  
Net income (loss) 582         399     183
Distributions paid to noncontrolling interests (152)               (152)
Other comprehensive income (loss) (24)       (24)        
Accretion of redeemable noncontrolling interests (4)     (4)          
Purchases (sales) of businesses and noncontrolling interests, net 51     27         24
Stock-based compensation expense, tax benefit and issuance of common stock (in shares)     1,873            
Stock-based compensation expense, tax benefit and issuance of common stock 61     61          
Ending balance (in shares) at Dec. 31, 2020     106,070            
Ending balance at Dec. 31, 2020 937   $ 7 4,844 (281) (2,128)   (2,414) 909
Changes in Shareholders' Equity                  
Net income (loss) 1,140         914     226
Distributions paid to noncontrolling interests (206)               (206)
Other comprehensive income (loss) 48       48        
Accretion of redeemable noncontrolling interests (11)     (11)          
Purchases (sales) of businesses and noncontrolling interests, net 97               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
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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Statement of Cash Flows [Abstract]      
Net income $ 1,476 $ 768 $ 171
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 855 857 850
Deferred income tax expense (benefit) 250 (128) 144
Stock-based compensation expense 56 44 42
Impairment and restructuring charges, and acquisition-related costs 85 290 185
Litigation and investigation costs 116 44 141
Net losses (gains) on sales, consolidation and deconsolidation of facilities (445) (14) 15
Loss from early extinguishment of debt 74 316 227
Equity in earnings of unconsolidated affiliates, net of distributions received (10) (37) (32)
Amortization of debt discount and debt issuance costs 33 38 35
Pre-tax loss (income) from discontinued operations 1 0 (15)
Other items, net (33) (29) (15)
Changes in cash from operating assets and liabilities:      
Accounts receivable (197) 195 (247)
Inventories and other current assets (52) (145) (94)
Income taxes 68 19 8
Accounts payable, accrued expenses, contract liabilities and other current liabilities (584) 1,302 12
Other long-term liabilities 28 221 3
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements (153) (333) (192)
Net cash used in operating activities from discontinued operations, excluding income taxes 0 (1) (5)
Net cash provided by operating activities 1,568 3,407 1,233
Cash flows from investing activities:      
Purchases of property and equipment (658) (540) (670)
Purchases of businesses or joint venture interests, net of cash acquired (1,220) (1,177) (25)
Proceeds from sales of facilities and other assets — continuing operations 1,248 77 63
Proceeds from sales of facilities and other assets — discontinued operations 0 0 17
Proceeds from sales of marketable securities, long-term investments and other assets 31 59 82
Purchases of marketable securities and equity investments (108) (44) (62)
Other items, net (7) 17 (24)
Net cash used in investing activities (714) (1,608) (619)
Cash flows from financing activities:      
Repayments of borrowings under credit facility 0 (740) (2,640)
Proceeds from borrowings under credit facility 0 740 2,640
Repayments of other borrowings (3,221) (3,293) (6,131)
Proceeds from other borrowings 2,872 3,818 5,719
Debt issuance costs (31) (48) (70)
Distributions paid to noncontrolling interests (423) (287) (307)
Proceeds from sale of noncontrolling interests 25 14 21
Purchases of noncontrolling interests (27) (39) (11)
Medicare advances and grants received by unconsolidated affiliates, net of recoupment (67) 187 0
Other items, net (64) 33 16
Net cash provided by (used in) financing activities (936) 385 (763)
Net increase (decrease) in cash and cash equivalents (82) 2,184 (149)
Cash and cash equivalents at beginning of period 2,446 262 411
Cash and cash equivalents at end of period 2,364 2,446 262
Supplemental disclosures:      
Interest paid, net of capitalized interest (937) (962) (946)
Income tax payments, net $ (92) $ (12) $ (12)
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SIGNIFICANT ACCOUNTING POLICIES
 12 Months Ended
Dec. 31, 2021
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. Through an expansive care network that includes our subsidiary USPI Holding Company, Inc. (“USPI”), at December 31, 2021, we operated 60 hospitals and 535 other healthcare facilities. We hold noncontrolling interests in 167 of these facilities, which are recorded using the equity method of accounting. At December 31, 2021, we held an ownership interest in USPI of approximately 95%. We also operate Conifer Health Solutions, LLC through our Conifer Holdings, Inc. subsidiary (“Conifer”). We owned an interest of approximately 76% in Conifer Health Solutions, LLC at December 31, 2021.

Our business consists of our Hospital Operations and other (“Hospital Operations”) segment, our Ambulatory Care segment and our Conifer segment. Our Hospital Operations segment is comprised of our acute care and specialty hospitals, imaging centers, ancillary outpatient facilities, micro‑hospitals and physician practices. Our Ambulatory Care segment is comprised of the operations of USPI, which holds ownership interests in ambulatory surgery centers and surgical hospitals. Our Conifer segment provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients.

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).

Effective January 1, 2020, we adopted the Financial Accounting Standards Board (“FASB”) Accounting Standards Update (“ASU”) 2016‑13, “Financial Instruments—Credit Losses (Topic 326) Measurement of Credit Losses on Financial Instruments” (“ASU 2016‑13”) using the modified retrospective transition approach as of the period of adoption. The amendments in this ASU required a financial asset (or a group of financial assets) measured at amortized cost basis to be presented at the net amount expected to be collected. The allowance for credit losses is a valuation account that is deducted from the amortized cost basis of the financial asset(s) to present the net carrying value at the amount expected to be collected on the financial asset. Upon adoption of ASU 2016‑13 on January 1, 2020, we recorded a cumulative effect adjustment to increase accumulated deficit by $14 million.

Effective January 1, 2019, we adopted ASU 2016‑02, “Leases (Topic 842)” (“ASU 2016‑02”) using the modified retrospective transition approach as of the period of adoption. Our financial statements for periods prior to January 1, 2019 were not modified for the application of the new lease accounting standard. The main difference between the guidance in ASU 2016‑02 and previous accounting principles generally accepted in the United States of America (“GAAP”) is the recognition of lease assets and lease liabilities on the balance sheet by lessees for those leases classified as operating leases under previous GAAP. Upon adoption of ASU 2016‑02, we recorded $822 million of right‑of‑use assets, net of deferred rent, associated with operating leases in investments and other assets in our consolidated balance sheet, $147 million of current liabilities associated with operating leases in other current liabilities in our consolidated balance sheet and $715 million of long‑term liabilities associated with operating leases in other long‑term liabilities in our consolidated balance sheet. We also recognized $1 million of cumulative effect adjustment that decreased accumulated deficit at January 1, 2019.

Certain prior‑year amounts have been reclassified to conform to the current year presentation. In our consolidated balance sheets, income tax receivable has been reclassified to other current assets, as it is no longer significant enough to present separately. In our consolidated statements of cash flows, long‑term assets has been combined with other items, net, as it is no longer significant enough to present separately, but it remains located within cash flows from investing activities. In addition, within the financing section of our statement of cash flows, proceeds from shares issued under stock‑based compensation plans, net of taxes paid related to net share settlement has been combined with other items, net.
Use of Estimates
The preparation of financial statements in conformity with 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. 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 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 2020 and 2021, COVID-19 impacted all three segments of our business, as well as our patients, communities and employees. Federal, state and local authorities undertook several actions in 2020 and 2021 designed to assist healthcare providers in providing care to COVID‑19 and other patients and to mitigate the adverse economic impact of the COVID‑19 pandemic. Among other things, the legislative actions taken by the federal government to respond to the COVID‑19 pandemic (collectively, the “COVID Acts”) authorized aggregate grant payments of $178 billion to be distributed through the Public Health and Social Services Emergency Fund (“PRF”) to health care providers who experienced lost revenues and increased expenses during the pandemic. The COVID Acts also revised the Medicare accelerated payment program to disburse payments to hospitals and other care providers more quickly and permitted employers to defer payment of the 6.2% employer Social Security tax beginning March 27, 2020 through December 31, 2020. Our participation in these programs and the related accounting policies are summarized below.

Grant Income—During the years ended December 31, 2021 and 2020, we received cash payments of $215 million and $974 million, including cash received by our unconsolidated affiliates, from the PRF and state and local grant programs. As a condition to receiving distributions, providers must agree to certain terms and conditions, including, among other things, that the funds are being used for lost revenues and unreimbursed COVID‑related costs as defined by the U.S. Department of Health and Human Services (“HHS”), and that the providers will 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 provided 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. In June 2021, HHS established new deadlines for when recipients of PRF grants must use the funding received, generally 12 to 18 months after receipt of the grant funds. HHS will recoup PRF grant funds not utilized by the established deadlines.

The table below summarizes grant funds received by our Hospital Operations and Ambulatory Care segments and by our unconsolidated affiliates for which we provide cash management services during the years ended December 31, 2021 and 2020, and their location in the accompanying Consolidated Statements of Cash Flows. There was no grant fund activity during the year ended December 31, 2019.
Years Ended December 31,
20212020
Grant payments received from COVID-19 relief programs:
Included in cash flows from operating activities:
Hospital Operations$142 $824 
Ambulatory Care36 76 
$178 $900 
Included in cash flows from financing activities:
Unconsolidated affiliates for which we provide cash management services$37 $74 

We recognize grant payments as income when there is reasonable assurance that we have complied with the conditions associated with the grant. Our estimates could change materially in the future based on our operating performance or COVID‑19 activities, as well as the government’s grant compliance guidance. Grant income recognized by our Hospital Operations and Ambulatory Care segments is presented in grant income and grant income recognized through our unconsolidated affiliates is presented in equity in earnings of unconsolidated affiliates in the accompanying Consolidated Statements of Operations.
The table below summarizes grant income recognized by our Hospital Operations and Ambulatory Care segments during the years ended December 31, 2021 and 2020. In addition, the table presents grant income recognized by our unconsolidated affiliates during 2021 and 2020, which is included in equity in earnings of unconsolidated affiliates in our consolidated statement of operations. No grant income was recognized during the year ended December 31, 2019.
Years Ended December 31,
20212020
Grant income recognized from COVID-19 relief programs:
Included in grant income:
Hospital Operations$142 $823 
Ambulatory Care49 59 
$191 $882 
 Included in equity in earnings of unconsolidated affiliates:
Unconsolidated affiliates$14 $17 

At December 31, 2021 and 2020, we had remaining deferred grant payment balances of $5 million and $18 million, respectively, which amounts were recorded in other current liabilities in the accompanying Consolidated Balance Sheets for those periods.

Medicare Accelerated Payment Program—In certain circumstances, when a hospital 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 Medicare accelerated payment program. The COVID Acts revised the Medicare accelerated payment program to disburse payments to healthcare providers more quickly. Recipients may retain the accelerated payments for one year from the date of receipt before recoupment commences, which is effectuated by a 25% offset of claims payments for 11 months, followed by a 50% offset for the succeeding six months. At the end of the 29‑month period, interest on the unrecouped balance will be assessed at 4.00% per annum. The initial 11‑month recoupment period began in April 2021.

Our Hospital Operations and Ambulatory Care segments both received advance payments from the Medicare accelerated payment program during 2020. No additional advances were received in the year ended December 31, 2021. During the year ended December 31, 2021, $457 million of advances received by our Hospital Operations segment and $36 million of advances received by our Ambulatory Care segment were recouped through a reduction of our Medicare claims payments. Also in 2021, $40 million of advances received by our unconsolidated affiliates for which we provide cash management services were recouped through a reduction of those affiliates’ Medicare claims payments. In addition to the amounts recouped during the year ended December 31, 2021, our Ambulatory Care segment repaid $83 million of advances, including $64 million for advances received by our unconsolidated affiliates for which we provide cash management services. In the accompanying Consolidated Balance Sheets, advances totaling $880 million and $603 million were included in contract liabilities at December 31, 2021 and December 31, 2020, respectively, and advances totaling $902 million were included in contract liabilities – long term at December 31, 2020.

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 are required to be paid in equal amounts over two years, with payments due in December 2021 and December 2022. We remitted the first portion of the deferred Social Security tax payments in December 2021. At December 31, 2021, deferred Social Security tax payments totaling $128 million were included in accrued compensation and benefits in the accompanying Consolidated Balance Sheets.

Translation of Foreign Currencies
We formed our Global Business Center (“GBC”) in the Philippines during the year ended December 31, 2019. 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 operating revenues for our Conifer segment primarily consist of revenues from providing revenue cycle management services to health systems, individual hospitals and physician practices.

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 (“FASB 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 provided to third‑party payers, discounts provided to uninsured patients in accordance with our Compact, and implicit price concessions provided 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 with these classes of patients 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.

Revenues under the traditional fee‑for‑service (“FFS”) Medicare and Medicaid programs are based primarily on prospective payment systems. Retrospectively determined cost‑based revenues under these programs, which were more prevalent in earlier periods, and certain other payments, such as Indirect Medical Education, Direct Graduate Medical Education, disproportionate share hospital and bad debt expense reimbursement, which are based on our hospitals’ cost reports, are estimated using historical trends and current factors. Cost report settlements under these programs are subject to audit by Medicare and Medicaid auditors and administrative and judicial review, and it can take several years until final settlement of such matters is determined and completely resolved. 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.
We have a system and estimation process for recording Medicare net patient service revenue and estimated cost report settlements. As a result, we record accruals to reflect the expected final settlements on our cost reports. For filed cost reports, we record the accrual based on those cost reports and subsequent activity and record a valuation allowance against those cost reports based on historical settlement trends. The accrual 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 as previously described. Cost reports generally must be filed within five months after the end of the annual cost 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.

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. 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.

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. 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 have provided implicit price concessions, primarily 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.

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 Conifer’s 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.

Conifer Revenues—Our Conifer segment recognizes revenue from its contracts when Conifer’s performance obligations are satisfied, which is generally as services are rendered. Revenue is recognized in an amount that reflects the consideration to which Conifer expects to be entitled.

At contract inception, Conifer assesses the services specified in its contracts with customers and identifies a performance obligation for each distinct contracted service. Conifer identifies the performance obligations and considers all the services provided under the contract. Conifer generally considers 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.

Conifer’s contracts generally consist of fixed‑price, volume‑based or contingency‑based fees. Conifer’s long‑term contracts typically provide for Conifer to deliver recurring monthly services over a multi‑year period. The contracts are typically priced such that Conifer’s monthly fee to its 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 Conifer 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 Conifer’s 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.

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 $2.364 billion and $2.446 billion at December 31, 2021 and 2020, respectively. At December 31, 2021 and 2020, our book overdrafts were $226 million and $154 million, respectively, which were classified as accounts payable. At December 31, 2021 and 2020, $188 million and $166 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, 2021, 2020 and 2019, we had $95 million, $93 million and $136 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $88 million, $85 million and $119 million, respectively, were included in accounts payable.
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, 2021, 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) unless we determine that a loss is other‑than‑temporary, at which point we would 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 expense, 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
We control 257 of the facilities within our Ambulatory Care segment and, therefore, consolidate their results. We account for many of the facilities our Ambulatory Care segment operates (166 of 423 at December 31, 2021), 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 years ended December 31, 2021 and 2020, equity in earnings of unconsolidated affiliates included $14 million and $17 million, respectively, from PRF grants recognized by our Ambulatory Care segment’s unconsolidated affiliates.

Summarized financial information for these equity method investees is included in the following table. For investments acquired during the reported periods, amounts reflect 100% of the investee’s results beginning on the date of our acquisition of the investment.
December 31,
 202120202019
Current assets$1,176 $1,309 $1,180 
Noncurrent assets$1,390 $1,262 $1,042 
Current liabilities$(495)$(516)$(372)
Noncurrent liabilities$(855)$(866)$(739)
Noncontrolling interests$(659)$(621)$(579)
 Years Ended December 31,
 202120202019
Net operating revenues$3,030 $2,665 $2,680 
Net income$836 $702 $765 
Net income attributable to the investees$499 $437 $499 

Our equity method investment that contributes the most to our equity in earnings of unconsolidated affiliates is Texas Health Ventures Group, LLC (“THVG”), which is operated by USPI. THVG represented $107 million, $85 million and $79 million of total equity in earnings of unconsolidated affiliates of $218 million, $169 million and $175 million in the years ended December 31, 2021, 2020 and 2019, 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, 2021, 2020 and 2019, capitalized interest was $4 million, $5 million and $11 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 appraisals, established market values of comparable assets or internal 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 appraisals, established market prices for comparable assets or internal estimates of future net cash flows.

Leases
ASU 2016-02 was issued to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. Our adoption of ASU 2016-02 was accomplished using a modified retrospective method of application, and our accounting policies related to leases were revised accordingly effective January 1, 2019, as discussed below.

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 and Conifer segments, 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 (i) expired or existing contracts for whether they are or contain a lease, (ii) the lease classification of any existing leases or (iii) 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. For goodwill, we perform the test at the reporting unit level when events occur that require an evaluation to be performed or at least annually. 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 appraisals, established market prices for comparable assets or internal 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, when they are probable and can be reasonably estimated. The accrual, which includes an estimate of incurred but not reported claims, is updated each quarter based on a model of projected payments using case‑specific facts and circumstances and our historical loss reporting, development and settlement patterns. To the extent that subsequent claims information varies from our estimates, the liability is adjusted in the period such information becomes available. Malpractice expense is presented within other operating expenses in the accompanying 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
We primarily operate acute care hospitals and related healthcare facilities. Our Hospital Operations segment generated 80% of our net operating revenues in the year ended December 31, 2021 and 81% during both of the years ended December 31, 2020 and 2019. At December 31, 2021, each of our markets related to our general hospitals reported directly to our chief executive officer. 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.
v3.22.0.1
NONCONTROLLING INTERESTS
 12 Months Ended
Dec. 31, 2021
Stockholders' Equity Note [Abstract]  
NONCONTROLLING INTERESTS NONCONTROLLING INTERESTSOur noncontrolling interests balances at December 31, 2021 and 2020 in the accompanying Consolidated Statements of Changes in Equity were comprised of $128 million and $116 million, respectively, from our Hospital Operations segment, and $898 million and $793 million, respectively, from our Ambulatory Care segment. Our net income attributable to noncontrolling interests for the years ended December 31, 2021, 2020 and 2019 were comprised of $21 million, $14 million and $16 million, respectively, from our Hospital Operations segment, and $205 million, $169 million and $178 million, respectively, from our Ambulatory Care segment.
v3.22.0.1
ACCOUNTS RECEIVABLE
 12 Months Ended
Dec. 31, 2021
Accounts Receivable Additional Disclosures [Abstract]  
ACCOUNTS RECEIVABLE ACCOUNTS RECEIVABLE
The principal components of accounts receivable are shown in the table below:
December 31,
 20212020
Continuing operations:  
Patient accounts receivable$2,600 $2,499 
Estimated future recoveries137 156 
Net cost reports and settlements receivable and valuation allowances33 34 
 2,770 2,689 
Discontinued operations— 1 
Accounts receivable, net 
$2,770 $2,690 

Accounts that are pursued for collection through Conifer’s business offices are maintained on our hospitals’ books and reflected in patient accounts receivable. 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 paying with 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,
 20212020
Assets:
Other current assets$370 $378 
Investments and other assets$213 $206 
Liabilities:
Other current liabilities$123 $110 
Other long-term liabilities$60 $56 

The following table shows our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses and which exclude the costs of our now-divested health plan businesses) of caring for our uninsured and charity patients:
 Years Ended December 31,
 202120202019
Estimated costs for:   
Uninsured patients$650 $617 $664 
Charity care patients97 147 156 
Total $747 $764 $820 
v3.22.0.1
CONTRACT BALANCES
 12 Months Ended
Dec. 31, 2021
Revenue from Contract with Customer [Abstract]  
CONTRACT BALANCES CONTRACT BALANCES
Hospital Operations Segment
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. For our Hospital Operations segment, our contract assets include services that we have provided to patients who are still receiving inpatient care in our facilities at the end of the reporting period. Our Hospital Operations segment’s contract assets were included in other current assets in the accompanying Consolidated Balance Sheets at December 31, 2021 and 2020. Approximately 91% 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.

In certain circumstances, when a hospital 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 Medicare accelerated payment program. As discussed in Note 1, the COVID Acts revised the Medicare accelerated payment program to disburse payments more quickly. During the year ended December 31, 2020, our Hospital Operations segment received advance payments from the Medicare accelerated payment program following its expansion under the COVID Acts. No additional advances were received during the year ended December 31, 2021. The advance payments received were recorded as contract liabilities in the accompanying Consolidated Balance Sheets at December 31, 2021 and 2020.

The opening and closing balances of contract assets and contract liabilities for our Hospital Operations segment were as follows:
Contract Liability –Contract Liability –
CurrentLong-term
Contract AssetsAdvances from MedicareAdvances from Medicare
December 31, 2020$208 $510 $819 
December 31, 2021181 876 — 
Increase (decrease)$(27)$366 $(819)
December 31, 2019$170 $— $— 
December 31, 2020208 510 819 
Increase$38 $510 $819 
Ambulatory Care Segment
During the year ended December 31, 2020, our Ambulatory Care segment also received advance payments from the Medicare accelerated payment program. In addition to the advances received by our Ambulatory Care segment, contract liabilities and contract liabilities – long‑term in the accompanying Consolidated Balance Sheet included $51 million and $62 million, respectively, of Medicare advance payments received by our unconsolidated affiliates for which we provide cash management services at December 31, 2020.

The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows:
Contract Liability –Contract Liability –
CurrentLong-term
Advances from MedicareAdvances from Medicare
December 31, 2020$93 $83 
December 31, 20214 — 
Decrease$(89)$(83)
December 31, 2019$— $— 
December 31, 202093 83 
Increase$93 $83 

Conifer Segment
The opening and closing balances of Conifer’s receivables, contract asset, and current and long‑term contract liabilities were as follows:
Contract Liability –Contract Liability –
Contract Asset –CurrentLong-Term
ReceivablesUnbilled RevenueDeferred RevenueDeferred Revenue
December 31, 2020$56 $20 $56 $16 
December 31, 202128 18 79 15 
Increase (decrease)$(28)$(2)$23 $(1)
December 31, 2019$26 $11 $61 $18 
December 31, 202056 20 56 16 
Increase (decrease)$30 $9 $(5)$(2)

The differences between the opening and closing balances of Conifer’s contract assets and contract liabilities are primarily related to prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are typically not distinct and are, therefore, recognized over the performance obligation period to which they relate. Our Conifer segment’s receivables and contract assets were reported as part of other current assets in the accompanying Consolidated Balance Sheets, and its current and long‑term contract liabilities were reported as part of contract liabilities and contract liabilities – long‑term, respectively, in the accompanying Consolidated Balance Sheets.

In the years ended December 31, 2021 and 2020, Conifer recognized $56 million and $61 million, respectively, of revenue that was included in the opening current deferred revenue liability. This revenue consists primarily of prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are recognized over the services period.

Contract Costs
We recognized amortization expense related to deferred contract setup costs of $4 million in both of the years ended December 31, 2021 and 2020, and $5 million in the year ended December 31, 2019. At December 31, 2021 and 2020, the unamortized customer contract costs were $23 million and $24 million, respectively, and were presented as part of investments and other assets in the accompanying Consolidated Balance Sheets.
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 with Uninsured Patients and other uninsured discount and charity programs. Net operating revenues for our Conifer segment primarily consist of revenues from providing revenue cycle management services to health systems, individual hospitals and physician practices.

The table below shows our sources of net operating revenues less implicit price concessions from continuing operations:
Years Ended December 31,
202120202019
Hospital Operations:
Net patient service revenues from hospitals and related outpatient facilities:
Medicare$2,615 $2,695 $2,888 
Medicaid1,254 1,081 1,193 
Managed care9,985 9,022 9,516 
Uninsured199 162 92 
Indemnity and other706 658 679 
Total14,759 13,618 14,368 
Other revenues(1)
1,223 1,172 1,154 
Hospital Operations total prior to inter-segment eliminations15,982 14,790 15,522 
Ambulatory Care2,718 2,072 2,158 
Conifer1,267 1,306 1,372 
Inter-segment eliminations(482)(528)(573)
Net operating revenues$19,485 $17,640 $18,479 
(1) Primarily physician practices revenues.

Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the years ended December 31, 2021, 2020 and 2019 by $26 million, $6 million and $27 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 table below shows the composition of net operating revenues for our Ambulatory Care segment:
Years Ended December 31,
202120202019
Net patient service revenues
$2,604 $1,960 $2,040 
Management fees86 86 95 
Revenue from other sources28 26 23 
Net operating revenues$2,718 $2,072 $2,158 
The table below shows the composition of net operating revenues for our Conifer segment:
Years Ended December 31,
202120202019
Revenue cycle services – Tenet$467 $514 $556 
Revenue cycle services – other customers705 700 713 
Other services – Tenet15 14 17 
Other services – other customers80 78 86 
Net operating revenues$1,267 $1,306 $1,372 

Other services represented approximately 7% of Conifer’s revenue for the year ended December 31, 2021 and included value‑based care services, consulting services and other client‑defined projects.

Performance Obligations
The following table includes Conifer’s revenue 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, performance incentives, penalties or other variable consideration that is considered constrained. Conifer’s 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
 Total20222023202420252026
Performance obligations$6,181 $606 $606 $552 $552 $552 $3,313 
v3.22.0.1
ASSETS AND LIABILITIES HELD FOR SALE
 12 Months Ended
Dec. 31, 2021
Discontinued Operations and Disposal Groups [Abstract]  
ASSETS AND LIABILITIES HELD FOR SALE ASSETS AND LIABILITIES HELD FOR SALE
In August 2021, we completed the sale of five Miami‑area hospitals and certain related operations (the “Miami Hospitals”) held by our Hospital Operations segment. We recognized a pre‑tax gain on sale of $406 million during the year ended December 31, 2021, which was included in net losses (gains) on sales, consolidation and deconsolidation of facilities in the accompanying Consolidated Statement of Operations.

In the three months ended June 30, 2021, we completed the sale of the majority of our urgent care centers operated under the MedPost and CareSpot brands by our Hospital Operations and Ambulatory Care segments. During the same period, we also completed the sale of a building we owned in the Philadelphia area that was held by our Hospital Operations segment. The assets and liabilities related to the urgent care centers and the building were classified as held for sale at December 31, 2020 in the accompanying Consolidated Balance Sheet. We recorded pre‑tax gains of $14 million and $2 million related to the sale of the urgent care centers and the sale of the building in Philadelphia, respectively, in the year ended December 31, 2021.

In the fourth quarter of 2019, we reached a definitive agreement to sell two of our hospitals and other operations in the Memphis area and we classified the related assets and liabilities as held for sale in our consolidated balance sheet at December 31, 2019. Following action by the U.S. Federal Trade Commission to challenge the proposed transaction, we determined in December 2020 that we no longer intend to pursue the sale of the hospitals and related operations. These assets and liabilities were removed from assets and liabilities held for sale in December 2020 and reclassified as held and used in our consolidated balance sheet.

In the first quarter of 2019, we completed the sale of three of our hospitals in the Chicago area, as well as other operations affiliated with the hospitals; these assets and liabilities were classified as held for sale beginning in the fourth quarter of 2017. Related to this transaction, we recorded loss on sale of $5 million and $14 million in the years ended December 31, 2020 and December 31, 2019, respectively.

Gains and losses related to the sales described above were included in net losses (gains) on sales, consolidation and deconsolidation of facilities in the accompanying Consolidated Statements of Operations in the respective years in which they were realized.

During the year ended December 31, 2019, we recognized an impairment charge of $26 million for the write‑down of assets held for sale to their estimated fair value, less estimated costs to sell, as a result of planned divestitures. No impairment charge was incurred during the years ended December 31, 2021 and 2020 related to planned divestitures.

The following table provides information on significant components of our business that were recently disposed of:
 Years Ended December 31,
 202120202019
Significant disposals:  
Income (loss) from continuing operations, before income taxes:
Chicago-area hospitals (includes a $5 million loss on sale in the 2020 period and a $14 million loss on sale in the 2019 period)
$(2)$3 $(19)
Miami Hospitals (includes a $406 million gain on sale in 2021)
455 67 44 
Total$453 $70 $25 
v3.22.0.1
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS
 12 Months Ended
Dec. 31, 2021
Restructuring Costs and Asset Impairment Charges [Abstract]  
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTSWe recognized impairment charges on long‑lived assets in 2021, 2020 and 2019 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 appraisals, established market values of comparable assets, or internal 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 hospitals, how the hospitals 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 hospital assets in the future to a marketplace participant is other than as a hospital. In these cases, the estimates are based on the fair value of the real property and equipment if utilized other than as a hospital. The impairment recognized does not include the costs of closing the hospitals or other future operating costs, which could be substantial. Accordingly, the ultimate net cash realized from the hospitals, 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.

At December 31, 2021, our continuing operations consisted of three reportable segments – Hospital Operations, Ambulatory Care and Conifer. Our segments are reporting units used to perform our goodwill impairment analysis. We completed our annual impairment tests for goodwill as of October 1, 2021.

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 offshore 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, 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. Impairments 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. Our impairment charges for the year ended December 31, 2021 were comprised of $5 million from our Ambulatory Care segment and $3 million from our Conifer segment. Acquisition‑related costs consisted of $20 million of transaction costs.

Year Ended December 31, 2020
During the year ended December 31, 2020, we recorded impairment and restructuring charges and acquisition‑related costs of $290 million, consisting of $92 million of impairment charges, $184 million of restructuring charges and $14 million of acquisition‑related costs. Impairment charges included $76 million for the write‑down of hospital buildings 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 the estimated future cash flows. We believe the most significant factors contributing to the adverse financial trends included reductions in volumes of insured patients, shifts in payer mix from commercial to governmental payers combined with reductions in reimbursement rates from governmental payers, and high levels of uninsured patients. 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 $483 million at December 31, 2020. We also recorded $16 million of other impairment charges. Restructuring charges consisted of $65 million of employee severance costs, $50 million related to the transitioning of various administrative functions to our GBC, $23 million of charges due to the termination of the USPI management equity plan, $14 million of contract and lease termination fees, and $32 million of other restructuring costs. Acquisition‑related costs consisted of $14 million of transaction costs. Our impairment charges for the year ended December 31, 2020 were comprised of $79 million from our Hospital Operations segment, $12 million from our Ambulatory Care segment and $1 million from our Conifer segment.

Year Ended December 31, 2019
During the year ended December 31, 2019, we recorded impairment and restructuring charges and acquisition‑related costs of $185 million, consisting of $42 million of impairment charges, $137 million of restructuring charges and $6 million of acquisition‑related costs. Impairment charges consisted of $26 million of charges to write‑down assets held for sale to their estimated fair value, less estimated costs to sell, for certain of our Memphis-area facilities and $16 million of other impairment charges. Of the total impairment charges recognized for the year ended December 31, 2019, $31 million related to our Hospital Operations segment, $6 million related to our Ambulatory Care segment, and $5 million related to our Conifer segment. Restructuring charges consisted of $57 million of employee severance costs, $28 million related to the transitioning of various administrative functions to our GBC, $6 million of contract and lease termination fees, and $46 million of other restructuring costs. Acquisition‑related costs consisted of $6 million of transaction costs.
v3.22.0.1
LEASES
 12 Months Ended
Dec. 31, 2021
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 at:
December 31,
Component of Lease BalancesClassification in Consolidated Balance Sheet20212020
Assets:  
Operating lease assetsInvestments and other assets$1,002 $1,062 
Finance lease assets
Property and equipment, at cost, less
accumulated depreciation and amortization
333 345 
Total leased assets$1,335 $1,407 
Liabilities:
Operating lease liabilities:
CurrentOther current liabilities$201 $188 
Long-termOther long-term liabilities924 999 
Total operating lease liabilities1,125 1,187 
Finance lease liabilities:
CurrentCurrent portion of long-term debt106 122 
Long-termLong-term debt, net of current portion176 151 
Total finance lease liabilities282 273 
Total lease liabilities$1,407 $1,460 

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,
202120202019
Operating lease expenseOther operating expenses, net$241 $247 $211 
Finance lease expense:
Amortization of leased assetsDepreciation and amortization71 86 85 
Interest on lease liabilitiesInterest expense9 11 15 
Total finance lease expense80 97 100 
Variable and short term-lease expenseOther operating expenses, net171 156 133 
Total lease expense$492 $500 $444 

The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table:
Years Ended December 31,
202120202019
Weighted-average remaining lease term (years):
Operating leases7.57.97.8
Finance leases5.75.75.4
Weighted-average discount rate:
Operating leases5.1 %5.5 %5.6 %
Finance leases5.4 %5.6 %5.5 %
Cash flow and other information related to leases is included in the following table:
Years Ended December 31,
202120202019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases$237 $239 $197 
Operating cash outflows from finance leases$12 $15 $18 
Financing cash outflows from finance leases$140 $154 $151 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases$176 $304 $249 
Finance leases$136 $98 $141 

Future maturities of lease liabilities at December 31, 2021 are presented in the following table:
Operating LeasesFinance LeasesTotal
2022$236 $116 $352 
2023211 76 287 
2024185 48 233 
2025156 16 172 
2026124 11 135 
Later years456 83 539 
Total lease payments1,368 350 1,718 
Less: Imputed interest243 68 311 
Total lease obligations1,125 282 1,407 
Less: Current obligations201 106 307 
Long-term lease obligations$924 $176 $1,100 
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 at:
December 31,
Component of Lease BalancesClassification in Consolidated Balance Sheet20212020
Assets:  
Operating lease assetsInvestments and other assets$1,002 $1,062 
Finance lease assets
Property and equipment, at cost, less
accumulated depreciation and amortization
333 345 
Total leased assets$1,335 $1,407 
Liabilities:
Operating lease liabilities:
CurrentOther current liabilities$201 $188 
Long-termOther long-term liabilities924 999 
Total operating lease liabilities1,125 1,187 
Finance lease liabilities:
CurrentCurrent portion of long-term debt106 122 
Long-termLong-term debt, net of current portion176 151 
Total finance lease liabilities282 273 
Total lease liabilities$1,407 $1,460 

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,
202120202019
Operating lease expenseOther operating expenses, net$241 $247 $211 
Finance lease expense:
Amortization of leased assetsDepreciation and amortization71 86 85 
Interest on lease liabilitiesInterest expense9 11 15 
Total finance lease expense80 97 100 
Variable and short term-lease expenseOther operating expenses, net171 156 133 
Total lease expense$492 $500 $444 

The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table:
Years Ended December 31,
202120202019
Weighted-average remaining lease term (years):
Operating leases7.57.97.8
Finance leases5.75.75.4
Weighted-average discount rate:
Operating leases5.1 %5.5 %5.6 %
Finance leases5.4 %5.6 %5.5 %
Cash flow and other information related to leases is included in the following table:
Years Ended December 31,
202120202019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases$237 $239 $197 
Operating cash outflows from finance leases$12 $15 $18 
Financing cash outflows from finance leases$140 $154 $151 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases$176 $304 $249 
Finance leases$136 $98 $141 

Future maturities of lease liabilities at December 31, 2021 are presented in the following table:
Operating LeasesFinance LeasesTotal
2022$236 $116 $352 
2023211 76 287 
2024185 48 233 
2025156 16 172 
2026124 11 135 
Later years456 83 539 
Total lease payments1,368 350 1,718 
Less: Imputed interest243 68 311 
Total lease obligations1,125 282 1,407 
Less: Current obligations201 106 307 
Long-term lease obligations$924 $176 $1,100 
v3.22.0.1
LONG-TERM DEBT
 12 Months Ended
Dec. 31, 2021
Long-term Debt and Lease Obligation [Abstract]  
LONG-TERM DEBT LONG-TERM DEBT
The table below shows our long‑term debt included in the accompanying Consolidated Balance Sheets:
December 31,
 20212020
Senior unsecured notes:  
6.750% due 2023
$1,872 $1,872 
7.000% due 2025
— 478 
6.125% due 2028
2,500 2,500 
6.875% due 2031
362 362 
Senior secured first lien notes:  
4.625% due 2024
770 1,870 
4.625% due 2024
600 600 
7.500% due 2025
700 700 
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 — 
4.375% due 2030
1,450 — 
Senior secured second lien notes:
5.125% due 2025
— 1,410 
6.250% due 2027
1,500 1,500 
Finance leases, mortgage and other notes443 403 
Unamortized issue costs and note discounts(151)(176)
Total long-term debt15,646 15,719 
Less current portion135 145 
Long-term debt, net of current portion$15,511 $15,574 
Credit Agreement
We have a senior secured revolving credit facility that provides for revolving loans in an aggregate principal amount of up to $1.900 billion with a $200 million subfacility for standby letters of credit. We amended our credit agreement (as amended to date, the “Credit Agreement”) in April 2020 to, among other things, (i) increase the aggregate revolving credit commitments from the previous limit of $1.500 billion to $1.900 billion (the “Increased Commitments”), subject to borrowing availability, and (ii) increase the advance rate and raise limits on certain eligible accounts receivable in the calculation of the borrowing base, in each case, for an incremental period of 364 days. In April 2021, we further amended the Credit Agreement to, among other things, extend the availability of the Increased Commitments through April 22, 2022 and reduce the interest rate margins. At December 31, 2021, 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, $1.797 billion was available for borrowing at December 31, 2021.

The Credit Agreement continues to have a scheduled maturity date of September 12, 2024, and 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.

Outstanding revolving loans accrue interest depending on the type of loan at either (i) a base rate plus a margin ranging from 0.25% to 0.75% per annum, or (ii) the Euro Interbank Offered Rate plus a margin ranging from 1.25% to 1.75% per annum, 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.

Letter of Credit Facility
We have a letter of credit facility that provides for the issuance of standby and documentary letters of credit. In March 2020, we amended our letter of credit facility (as amended, the “LC Facility”) to extend the scheduled maturity date of the LC Facility from March 7, 2021 to September 12, 2024 and to increase the aggregate principal amount of standby and documentary letters of credit that from time to time may be issued thereunder from $180 million to $200 million. In July 2020, we further amended the LC Facility to incrementally increase the maximum secured debt covenant from 4.25 to 1.00 on a quarterly basis up to 6.00 to 1.00 for the quarter ended March 31, 2021, at which point the maximum ratio began to step down incrementally on a quarterly basis through the quarter ended December 31, 2021. At December 31, 2021, the effective maximum secured debt covenant was 4.25 to 1.00, where it will remain until maturity. 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.

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 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. At December 31, 2021, we had $139 million of standby letters of credit outstanding under the LC Facility and were in compliance with all applicable covenants and conditions.

Senior Secured Notes and Senior Unsecured Notes
On December 1, 2021, we issued $1.450 billion aggregate principal amount of 4.375% senior secured first lien notes, which will mature on January 15, 2030 (the “2030 Senior Secured First Lien Notes”). We will pay interest on the 2030 Senior Secured First Lien Notes semi‑annually in arrears on January 15 and July 15 of each year, commencing on July 15, 2022. We used the net proceeds from the issuance of the 2030 Senior Secured First Lien Notes, after payment of fees and expenses, to finance the acquisition of the SCD Centers in December 2021 and for general corporate purposes.

On September 10, 2021, we redeemed approximately $1.100 billion of the then‑outstanding $1.870 billion aggregate principal amount of our 4.625% senior secured first lien notes due 2024 in advance of their maturity date. We paid $1.113 billion to redeem the notes, which was primarily funded with the proceeds from the sale of the Miami Hospitals in August 2021. In connection with the redemption, we recorded a loss from early extinguishment of debt of $20 million in the three months ended September 30, 2021, primarily related to the difference between the purchase price and the par value of the notes, as well as the write‑off of associated unamortized issuance costs.
On June 2, 2021, we issued $1.400 billion aggregate principal amount of 4.250% senior secured first lien notes, which will mature on June 1, 2029 (the “2029 Senior Secured First Lien Notes”). We pay interest on the 2029 Senior Secured First Lien Notes semi‑annually in arrears on June 1 and December 1 of each year, which payments commenced on December 1, 2021. The proceeds from the sale of the 2029 Senior Secured First Lien Notes were used, after payment of fees and expenses, together with cash on hand, to finance the redemption of all $1.410 billion aggregate principal amount then outstanding of our 5.125% senior secured second lien notes due 2025 (the “2025 Senior Secured Second Lien Notes”) in advance of their maturity date for approximately $1.428 billion. In connection with the redemption, we recorded a loss from early extinguishment of debt of approximately $31 million in the three months ended June 30, 2021, primarily related to the difference between the purchase price and the par value of the 2025 Senior Secured Second Lien Notes, as well as the write‑off of associated unamortized issuance costs.

In March 2021, we retired all $478 million aggregate principal amount outstanding of our 7.000% senior unsecured notes due 2025 in advance of their maturity date. We paid approximately $495 million from cash on hand to retire the notes. In connection with the retirement, we recorded a loss from early extinguishment of debt of $23 million in the three months ended March 31, 2021, primarily related to the difference between the purchase price and the par value of the notes, as well as the write‑off of associated unamortized issuance costs.

In September 2020, we sold $2.500 billion aggregate principal amount of 6.125% senior notes, which will mature on October 1, 2028 (the “2028 Senior Notes”). We pay interest on the 2028 Senior Notes semi‑annually in arrears on April 1 and October 1 of each year, which payments commenced on April 1, 2021. The proceeds from the sale of the 2028 Senior Notes were used, after payment of fees and expenses, together with cash on hand, to finance the redemption of all $2.556 billion aggregate principal amount then outstanding of our 8.125% senior unsecured notes due 2022 (the “2022 Senior Notes”) for approximately $2.843 billion. In connection with the redemption, we recorded a loss from early extinguishment of debt of approximately $305 million in the three months ended September 30, 2020, primarily related to the difference between the purchase price and the par value of the 2022 Senior Notes, as well as the write‑off of associated unamortized issuance costs.

Through a series of transactions during June, July and August 2020, we purchased approximately $244 million aggregate principal amount of our 2022 Senior Notes for approximately $256 million. In connection with the purchases, we recorded a loss from early extinguishment of debt totaling $15 million in the year ended December 31, 2020, primarily related to the differences between the purchase prices and the par values of the 2022 Senior Notes, as well as the write‑off of associated unamortized issuance costs.

In June 2020, we sold $600 million aggregate principal amount of 4.625% senior secured first lien notes, which will mature on June 15, 2028 (the “2028 Senior Secured First Lien Notes”). We pay interest on the 2028 Senior Secured First Lien Notes semi‑annually in arrears on June 15 and December 15 of each year, which payments commenced on December 15, 2020.

In April 2020, we sold $700 million aggregate principal amount of 7.500% senior secured first lien notes, which will mature on April 1, 2025 (the “2025 Senior Secured First Lien Notes”). We pay interest on the 2025 Senior Secured First Lien Notes semi‑annually in arrears on April 1 and October 1 of each year, which payments commenced on October 1, 2020. A portion of the proceeds from the sale of the 2025 Senior Secured First Lien Notes was used, after payment of fees and expenses, to repay the $500 million aggregate principal amount of borrowings outstanding under our Credit Agreement as of March 31, 2020.

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 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.

Covenants
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.

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 4.0 to 1.0.

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.

Future Maturities
Future long‑term debt maturities, including finance lease obligations were as follows as of December 31, 2021:
  Years Ending December 31,Later Years
 Total20222023202420252026
Long-term debt, including finance lease obligations$15,797 $135 $1,983 $1,446 $742 $2,120 $9,371 

As discussed in Note 25, in February 2022, we announced the redemption of all $700 million aggregate principal amount outstanding of our 2025 Senior Secured First Lien Notes. These notes are included in the table above based on their stated maturity date.
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GUARANTEES
 12 Months Ended
Dec. 31, 2021
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, 2021, 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 $122 million. We had a total liability of $104 million recorded for these guarantees included in other current liabilities in the accompanying Consolidated Balance Sheet at December 31, 2021.

At December 31, 2021, 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 $94 million. Of the total, $12 million relates to the obligations of consolidated subsidiaries, which obligations were recorded in the accompanying Consolidated Balance Sheet at December 31, 2021.
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EMPLOYEE BENEFIT PLANS
 12 Months Ended
Dec. 31, 2021
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. 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 to directors vest immediately but settle upon separation from the board.

We also grant performance‑based stock options and 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. 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, 2021, assuming outstanding performance‑based stock options and RSUs for which performance has not yet been determined will achieve target performance, approximately 5.3 million 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 for the years ended December 31, 2021, 2020 and 2019 include $56 million, $44 million and $42 million, respectively, of pre‑tax compensation costs related to our stock‑based compensation arrangements.
The table below shows certain stock option and RSU grants and other awards, net of forfeitures, that comprise the stock‑based compensation expense recorded in the year ended December 31, 2021. 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.
Grant DateAwardsExercise Price
Per Share		Fair Value
Per Share at
Grant Date
Stock-Based
Compensation Expense for Year Ended December 31, 2021
 (In Thousands)  (In Millions)
Stock options:
February 27, 2019188 $28.26 $12.49 $1 
Restricted stock units:    
May 7, 202137 $47.99 2 
February 24, 2021585 $52.85 12 
February 26, 20201,221 $27.80 15 
February 27, 2019790 $28.26 5 
January 31, 2019318 $21.99 2 
Other grants(1)
661 $30.73 6 
Other stock-based compensation plans:
USPI management equity plan1,883  $34.13 13 
    $56 
(1)
Per-share value presented is the weighted-average grant date fair value of the grants included. Grant dates range from June 2016 to September 2021 with per‑share grant date fair values ranging from $18.11 to $74.99.

Stock Options
The following table summarizes stock option activity during the years ended December 31, 2021, 2020 and 2019:
 OptionsWtd. Avg.
Exercise Price
Per Share		Aggregate
Intrinsic Value		Wtd. Avg
Remaining Life
   (In Millions) 
Outstanding at December 31, 2018
2,262,743 $19.12   
Granted230,713 $28.28   
Exercised(306,427)$18.05   
Forfeited/Expired(226,037)$20.21   
Outstanding at December 31, 2019
1,960,992 $20.24   
Exercised(987,471)$17.96   
Forfeited/Expired(60,990)$23.28   
Outstanding at December 31, 2020
912,531 $22.51   
Exercised(391,533)$20.66   
Outstanding at December 31, 2021
520,998 $23.90 $30 6.2 years
Vested and expected to vest at December 31, 2021
520,998 $23.90 $30 6.2 years
Exercisable at December 31, 2021
324,980 $21.25 $20 5.7 years

No stock options were granted during the years ended December 31, 2021 and 2020. There were 391,533 stock options exercised during the year ended December 31, 2021 with an aggregated intrinsic value of approximately $15 million, and 987,471 stock options exercised in 2020 with an aggregate intrinsic value of approximately $15 million.
The following table summarizes information about our outstanding stock options at December 31, 2021:
 Options OutstandingOptions Exercisable
Range of Exercise Prices Number of
Options		Wtd. Avg.
Remaining
Contractual Life		Wtd. Avg.
Exercise Price		Number of
Options		Wtd. Avg.
Exercise Price
$18.99 to $20.609
293,796 5.6 years$19.75 293,796 $19.75 
$20.61 to $35.430
227,202 6.9 years29.26 31,184 35.43 
 520,998 6.2 years$23.90 324,980 $21.25 

As of December 31, 2021, 57.0% of all our outstanding options were held by current employees and 43.0% were held by former employees. Of our outstanding options, 100% were in‑the‑money, that is, they had exercise price less than the $81.69 market price of our common stock on December 31, 2021.
 In-the-Money OptionsOut-of-the-Money OptionsAll Options
 Outstanding% of TotalOutstanding% of TotalOutstanding% of Total
Current employees296,916 57.0 %— — %296,916 57.0 %
Former employees224,082 43.0 %— — %224,082 43.0 %
Totals520,998 100.0 %— — 520,998 100.0 %
% of all outstanding options100.0 % — % 100.0 % 

Restricted Stock Units
The following table summarizes RSU activity during the years ended December 31, 2021, 2020 and 2019:
 Restricted Stock UnitsWtd. Avg. Grant Date Fair Value Per Unit
Unvested at December 31, 2018
1,884,130 $32.25 
Granted1,481,021 $27.87 
Vested(1,562,191)$36.45 
Forfeited(339,461)$24.74 
Unvested at December 31, 2019
1,463,499 $25.08 
Granted1,767,730 $27.72 
Vested(825,727)$25.66 
Forfeited(310,296)$32.09 
Unvested at December 31, 2020
2,095,206 $25.87 
Granted900,018 $58.61 
Vested(765,814)$30.51 
Forfeited(58,208)$37.60 
Unvested at December 31, 2021
2,171,202 $40.51 

During the year ended December 31, 2021 we granted 561,788 RSUs that vest based on the passage of time. The granted RSUs vest as follows:

•263,180 RSUs vest and settle ratably over a three‑year period from the grant date;

•189,215 RSUs vest and settle ratably over eight quarterly periods from the grant date;

•53,341 RSUs vest and settle on the fourth anniversary of the grant date;

•33,351 RSUs vest and settle on the third anniversary of the grant date;

•14,192 RSUs vested on December 31, 2021 and settled in January 2022; and

•8,509 RSUs, one-third of which vest and settle on the second anniversary of the grant date and the remainder of which vest and settle on the fourth anniversary.
During the year ended December 31, 2021 we granted 298,492 performance-based RSUs which vest as follows:

•244,259 RSUs vest and settle on the third anniversary of the grant date, contingent upon the achievement of performance goals for the years 2021 to 2023;

•53,341 RSUs vest and settle on the fourth anniversary of the grant date, contingent upon the achievement of performance goals for the years 2021 to 2025; and

•892 RSUs vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2018.

The actual number of performance‑based RSUs that could vest will range from 0% to 200% of the 297,600 unvested RSUs granted, depending upon our level of achievement with respect to the performance goals.

During the year ended December 31, 2021, we also granted 39,738 RSUs to our non‑employee directors. These consisted of 36,681 RSUs for the 2021‑2022 board service year, 1,372 for an initial grant to a new member of our board of directors and 1,685 for a pro‑rata annual grant to the same new member. While RSUs granted to our board of directors vest immediately, annual grants settle on the third anniversary of the grant date and initial grants settle upon separation from the board.

During the year ended December 31, 2020 we granted 1,084,883 RSUs that vest based on the passage of time. The granted RSUs vest as follows:

•607,198 RSUs vest and settle ratably over a three‑year period from the grant date;

•359,713 RSUs vest and settle ratably over 11 quarterly periods from the grant date;

•104,167 RSUs vest and settle ratably over a four-year period from the grant date; and

•13,805 RSUs vest and settle on the third anniversary of the grant date.

During the year ended December 31, 2020 we granted 579,413 performance-based RSUs which vest as follows:

•499,285 RSUs vest and settle on the third anniversary of the grant date, contingent upon the achievement of performance goals for the years 2020 to 2022 and

•80,128 RSUs vest and settle on the fourth anniversary of the grant date, contingent upon the achievement of performance goals for the years 2020 to 2023, all of which were subsequently forfeited.

The actual number of performance‑based RSUs that could vest will range from 0% to 200% of the 499,285 remaining RSUs granted, depending upon our level of achievement with respect to the performance goals.

In May 2020, we made an annual grant of 103,434 RSUs to our non‑employee directors for the 2020-2021 board service year, which units vested immediately and will settle in shares of our common stock on the third anniversary of the date of the grant.

As of December 31, 2021, there were $47 million of total unrecognized compensation costs related to RSUs. These costs are expected to be recognized over a weighted average period of 1.7 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,
20212020
Expected volatility
65.2% - 79.3%
54.7 %
Risk-free interest rate
0.1% - 0.6%
1.2 %
USPI Management Equity Plan
2015 USPI Management Equity Plan
In 2015, USPI adopted the USPI Holding Company, Inc. 2015 Stock Incentive Plan (“2015 USPI Management Equity Plan”) under which it granted non-qualified options to purchase nonvoting shares of USPI’s outstanding common stock to eligible plan participants, allowing the recipient to participate in incremental growth in the value of USPI from the applicable grant date. Under the 2015 USPI Management Equity Plan, the total pool of options consisted of approximately 10% of USPI’s fully diluted outstanding common stock. Options had an exercise price equal to the estimated fair market value of USPI’s common stock on the date of grant. The option awards were structured such that they had a three or four year vesting period in which half of the award vested in equal pro-rata amounts over the applicable vesting period and the remaining half vested at the end of the applicable three or four year period. Any unvested awards were forfeited upon the participant’s termination of service with USPI, and vested options were required to have been exercised within 90 days of termination. Once an award was exercised and the requisite holding period met, the participant was eligible to sell the underlying shares to USPI at their estimated fair market value. Payment for USPI’s purchase of any eligible nonvoting common shares could be made in cash or in shares of Tenet’s common stock.

In February 2020, the 2015 USPI Management Equity Plan and all unvested options granted under the plan were terminated in accordance with the terms of the plan. USPI repurchased all vested options and all shares of USPI stock acquired upon exercise of an option for approximately $35 million.

2020 USPI Management Equity Plan
In February 2020, USPI adopted the USPI Holding Company, Inc. Restricted Stock Plan (“2020 USPI Management Equity Plan”) to replace the terminated 2015 USPI Management Equity Plan. Under the 2020 USPI Management Equity Plan, USPI 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 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 USPI’s management equity plan during the year ended December 31, 2021 and 2020:
Number of
Restricted Stock Units		Wtd. Avg. Grant
Date Fair Value Per Unit
Inception of Plan
Granted2,556,353 $34.13 
Forfeited(531,297)$34.13 
Unvested at December 31, 2020
2,025,056 $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 

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. In 2020, USPI granted 2,556,333 RSUs, 20% of which vest in each of the first three years on the anniversary of the grant date with the remaining 40% vesting on the fourth anniversary of the grant date.

During the year ended December 31, 2021, USPI paid $9.0 million to repurchase a portion of the non‑voting common stock issued under the USPI management equity plan. No shares were repurchased through the issuance of Tenet common stock during the year ended December 31, 2021.

At December 31, 2021, 1,494,882 RSUs were outstanding under USPI’s management equity plan, all of which are expected to vest. The accompanying Consolidated Statements of Operations for the years ended December 31, 2021, 2020 and 2019 included $13 million, $12 million and $11 million, respectively, of pre-tax compensation costs related to USPI’s management equity plans.
Employee Stock Purchase Plan
We have an employee stock purchase plan under which we are currently authorized to issue up to 4,070,363 shares of common stock to our eligible employees. As of December 31, 2021, there were approximately 2.7 million 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, 
 202120202019
Number of shares89,865 254,767 215,422 
Weighted average price$63.01 $19.97 $24.44 

Employee Retirement Plans
Substantially all of our employees, upon qualification, are eligible to participate in one of 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 by plan. Plan expenses, primarily related to our contributions to the plans, were $98 million, $119 million and $127 million for the years ended December 31, 2021, 2020 and 2019, respectively. Such amounts are reflected in salaries, wages and benefits in the accompanying Consolidated Statements of Operations.

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, 2019, the Society of Actuaries issued a new mortality base table (Pri‑2012), which we incorporated into the estimates of our defined benefit plan obligations beginning December 31, 2019. During the years ended December 31, 2021 and 2020, the Society of Actuaries issued new mortality improvement scales (MP‑2021 and MP‑2020, respectively), which we incorporated into the estimates of our defined benefit plan obligations at December 31, 2021 and 2020. These changes to our mortality assumptions increased our projected benefit obligations as of December 31, 2021 by approximately $5 million and decreased our projected benefit obligations as of December 31, 2020 by approximately $39 million.
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,
 20212020
Reconciliation of funded status of plans and the amounts included in the Consolidated Balance Sheets:  
Projected benefit obligations(1)
  
Beginning obligations$(1,429)$(1,369)
Interest cost(36)(47)
Actuarial gain (loss)42 (92)
Benefits paid110 79 
Ending obligations(1,313)(1,429)
Fair value of plans assets  
Beginning plan assets869 790 
Gain on plan assets62 98 
Employer contribution22 38 
Benefits paid(86)(57)
Ending plan assets867 869 
Funded status of plans$(446)$(560)
(1)The accumulated benefit obligation at December 31, 2021 and 2020 was approximately $1.311 billion and $1.426 billion, respectively.

 December 31,
 20212020
Amounts recognized in the Consolidated Balance Sheets consist of:  
Other current liability$(25)$(63)
Other long-term liability$(421)$(497)
Accumulated other comprehensive loss$294 $355 
SERP Assumptions:  
Discount rate3.00 %2.75 %
Compensation increase rate3.00 %3.00 %
Measurement dateDecember 31, 2021December 31, 2020
DMC Pension Plan Assumptions:  
Discount rate2.89 %2.53 %
Compensation increase rateFrozenFrozen
Measurement dateDecember 31, 2021December 31, 2020
The components of net periodic benefit costs and related assumptions are as follows:
 Years Ended December 31,
 202120202019
Interest costs$36 $47 $58 
Expected return on plan assets(53)(48)(46)
Amortization of net actuarial loss11 9 10 
Special termination benefit costs— — 1 
Net periodic benefit cost (income)$(6)$8 $23 
SERP Assumptions:   
Discount rate2.75 %3.50 %4.50 %
Compensation increase rate3.00 %3.00 %3.00 %
Measurement dateJanuary 1, 2021January 1, 2020January 1, 2019
Census dateJanuary 1, 2021January 1, 2020January 1, 2019
DMC Pension Plan Assumptions:   
Discount rate2.53 %3.60 %4.62 %
Long-term rate of return on assets6.25 %6.25 %6.50 %
Compensation increase rateFrozenFrozenFrozen
Measurement dateJanuary 1, 2021January 1, 2020January 1, 2019
Census dateJanuary 1, 2021January 1, 2020January 1, 2019

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 $61 million, $(32) million and $(42) million in other comprehensive income in the years ended December 31, 2021, 2020 and 2019, 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 $50 million, $(41) million and $(52) million were recognized during the years ended December 31, 2021, 2020 and 2019, respectively, and the amortization of net actuarial loss of $11 million, $9 million and $10 million for the years ended December 31, 2021, 2020 and 2019, respectively, were recognized in other comprehensive income. Actuarial gain (loss) affecting the benefit obligation during the years ended December 31, 2021, 2020 and 2019 are primarily attributable to changes in the discount rate utilized for the SERP and DMC Pension Plan. Cumulative net actuarial losses of $294 million, $355 million and $323 million as of December 31, 2021, 2020 and 2019, respectively. There were no unrecognized prior service costs at December 31, 2021 and 2020, and unrecognized prior service costs of less than $1 million at December 31, 2019 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, 2021, were as follows:
Asset CategoryTargetActual
Cash and cash equivalents— %1 %
Equity securities32 %28 %
Debt securities58 %59 %
Alternative investments11 %11 %

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.

The following tables summarize the DMC Pension Plan assets measured at fair value on a recurring basis as of December 31, 2021 and 2020, aggregated by the level in the fair value hierarchy within which those measurements are determined. 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 are unobservable data points for the asset or liability, and include situations where there is little, if any, market activity for the asset or liability.
 December 31, 2021Level 1Level 2Level 3
Cash and cash equivalents$11 $11 $— $— 
Equity securities242 242 — — 
Debt Securities:
U.S. government obligations67 67 — — 
Corporate debt securities448 448 — — 
Alternative investments:
Private equity securities57 — — 57 
Real estate securities16 16 — — 
Hedge funds26 — — 26 
 $867 $784 $— $83 

 December 31, 2020Level 1Level 2Level 3
Cash and cash equivalents$44 $44 $— $— 
Equity securities484 484 — — 
Debt Securities:
U.S. government obligations76 76 — — 
Corporate debt securities240 240 — — 
Alternative investments:
Private equity securities8 — — 8 
Hedge funds17 — 17 — 
 $869 $844 $17 $8 

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
 Total20222023202420252026
Estimated benefit payments$828 $83 $84 $85 $85 $85 $406 
The SERP and DMC Pension Plan obligations of $446 million at December 31, 2021 are classified in the accompanying Consolidated Balance Sheet as an other current liability of $25 million and defined benefit plan obligations of $421 million based on an estimate of the expected payment patterns. We expect to make total contributions to the plans of approximately $25 million for the year ending December 31, 2022.
v3.22.0.1
PROPERTY AND EQUIPMENT
 12 Months Ended
Dec. 31, 2021
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,
 20212020
Land$635 $612 
Buildings and improvements6,652 6,985 
Construction in progress166 33 
Equipment4,455 4,593 
Finance lease assets479 512 
 12,387 12,735 
Accumulated depreciation and amortization(5,960)(6,043)
Net property and equipment$6,427 $6,692 

Property and equipment is stated at cost, less accumulated depreciation and amortization and impairment write‑downs related to assets held and used.
v3.22.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS
 12 Months Ended
Dec. 31, 2021
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, which was included in the accompanying Consolidated Balance Sheets:
December 31,
 20212020
Hospital Operations  
Goodwill at beginning of period:  
Goodwill$5,375 $5,338 
Accumulated impairment losses(2,430)(2,430)
2,945 2,908 
Goodwill transferred from Ambulatory Care segment41 — 
Goodwill related to assets held for sale and disposed(178)37 
Goodwill at end of period$2,808 $2,945 
Goodwill at end of period:  
Goodwill$5,238 $5,375 
Accumulated impairment losses(2,430)(2,430)
Goodwill at end of period$2,808 $2,945 
Ambulatory Care
Goodwill at beginning of period$5,258 $3,739 
Goodwill acquired during the year and purchase price allocation adjustments664 1,581 
Goodwill transferred to Hospital Operations segment(41)— 
Goodwill related to assets held for sale and disposed or deconsolidated facilities(33)(62)
Goodwill at end of period$5,848 $5,258 
Conifer
Goodwill at beginning of period$605 $605 
Goodwill acquired during the year and purchase price allocation adjustments— — 
Goodwill related to assets held for sale and disposed or deconsolidated facilities— — 
Goodwill at end of period$605 $605 
There were no accumulated impairment losses related to the goodwill in our Ambulatory Care and Conifer segments at December 31, 2021 and 2020.

The following table provides information regarding other intangible assets, which were included in the accompanying Consolidated Balance Sheets as of December 31, 2021 and 2020:
 Gross
Carrying
Amount		Accumulated
Amortization		Net Book
Value
At December 31, 2021:   
Capitalized software costs$1,770 $(1,165)$605 
Trade names102 — 102 
Contracts897 (128)769 
Other102 (81)21 
Total$2,871 $(1,374)$1,497 
At December 31, 2020:   
Capitalized software costs$1,800 $(1,084)$716 
Trade names102 — 102 
Contracts872 (111)761 
Other110 (89)21 
Total$2,884 $(1,284)$1,600 

Estimated future amortization of intangibles with finite useful lives as of December 31, 2021 was as follows:
 TotalYears Ending December 31,Later Years
 20222023202420252026
Amortization of intangible assets$786 $147 $119 $108 $94 $73 $245 

We recognized amortization expense of $188 million, $172 million and $188 million in the accompanying Consolidated Statements of Operations for the years ended December 31, 2021, 2020 and 2019, respectively.
v3.22.0.1
INVESTMENTS AND OTHER ASSETS
 12 Months Ended
Dec. 31, 2021
Investments, Debt and Equity Securities [Abstract]  
INVESTMENTS AND OTHER ASSETS INVESTMENTS AND OTHER ASSETS
The principal components of investments and other assets in the accompanying Consolidated Balance Sheets are as follows:
 December 31,
 20212020
Marketable securities$9 $3 
Equity investments in unconsolidated healthcare entities1,806 1,024 
Total investments1,815 1,027 
Cash surrender value of life insurance policies47 42 
Long-term deposits57 67 
California provider fee program receivables213 206 
Operating lease assets1,002 1,062 
Land held for expansion, other long-term receivables and other assets120 130 
Investments and other assets$3,254 $2,534 
v3.22.0.1
ACCUMULATED OTHER COMPREHENSIVE LOSS
 12 Months Ended
Dec. 31, 2021
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]  
ACCUMULATED OTHER COMPREHENSIVE LOSS ACCUMULATED OTHER COMPREHENSIVE LOSS
Our accumulated other comprehensive loss is comprised of the following:
 December 31,
 20212020
Adjustments for defined benefit plans$(232)$(281)
Foreign currency translation adjustments and other(1)— 
Accumulated other comprehensive loss$(233)$(281)
The income tax benefits (expense) allocated to the adjustments for our defined benefit plans was approximately $(14) million and $7 million for the years ended December 31, 2021 and 2020, respectively.
v3.22.0.1
NET OPERATING REVENUES
 12 Months Ended
Dec. 31, 2021
Revenue from Contract with Customer [Abstract]  
NET OPERATING REVENUES CONTRACT BALANCES
Hospital Operations Segment
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. For our Hospital Operations segment, our contract assets include services that we have provided to patients who are still receiving inpatient care in our facilities at the end of the reporting period. Our Hospital Operations segment’s contract assets were included in other current assets in the accompanying Consolidated Balance Sheets at December 31, 2021 and 2020. Approximately 91% 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.

In certain circumstances, when a hospital 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 Medicare accelerated payment program. As discussed in Note 1, the COVID Acts revised the Medicare accelerated payment program to disburse payments more quickly. During the year ended December 31, 2020, our Hospital Operations segment received advance payments from the Medicare accelerated payment program following its expansion under the COVID Acts. No additional advances were received during the year ended December 31, 2021. The advance payments received were recorded as contract liabilities in the accompanying Consolidated Balance Sheets at December 31, 2021 and 2020.

The opening and closing balances of contract assets and contract liabilities for our Hospital Operations segment were as follows:
Contract Liability –Contract Liability –
CurrentLong-term
Contract AssetsAdvances from MedicareAdvances from Medicare
December 31, 2020$208 $510 $819 
December 31, 2021181 876 — 
Increase (decrease)$(27)$366 $(819)
December 31, 2019$170 $— $— 
December 31, 2020208 510 819 
Increase$38 $510 $819 
Ambulatory Care Segment
During the year ended December 31, 2020, our Ambulatory Care segment also received advance payments from the Medicare accelerated payment program. In addition to the advances received by our Ambulatory Care segment, contract liabilities and contract liabilities – long‑term in the accompanying Consolidated Balance Sheet included $51 million and $62 million, respectively, of Medicare advance payments received by our unconsolidated affiliates for which we provide cash management services at December 31, 2020.

The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows:
Contract Liability –Contract Liability –
CurrentLong-term
Advances from MedicareAdvances from Medicare
December 31, 2020$93 $83 
December 31, 20214 — 
Decrease$(89)$(83)
December 31, 2019$— $— 
December 31, 202093 83 
Increase$93 $83 

Conifer Segment
The opening and closing balances of Conifer’s receivables, contract asset, and current and long‑term contract liabilities were as follows:
Contract Liability –Contract Liability –
Contract Asset –CurrentLong-Term
ReceivablesUnbilled RevenueDeferred RevenueDeferred Revenue
December 31, 2020$56 $20 $56 $16 
December 31, 202128 18 79 15 
Increase (decrease)$(28)$(2)$23 $(1)
December 31, 2019$26 $11 $61 $18 
December 31, 202056 20 56 16 
Increase (decrease)$30 $9 $(5)$(2)

The differences between the opening and closing balances of Conifer’s contract assets and contract liabilities are primarily related to prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are typically not distinct and are, therefore, recognized over the performance obligation period to which they relate. Our Conifer segment’s receivables and contract assets were reported as part of other current assets in the accompanying Consolidated Balance Sheets, and its current and long‑term contract liabilities were reported as part of contract liabilities and contract liabilities – long‑term, respectively, in the accompanying Consolidated Balance Sheets.

In the years ended December 31, 2021 and 2020, Conifer recognized $56 million and $61 million, respectively, of revenue that was included in the opening current deferred revenue liability. This revenue consists primarily of prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are recognized over the services period.

Contract Costs
We recognized amortization expense related to deferred contract setup costs of $4 million in both of the years ended December 31, 2021 and 2020, and $5 million in the year ended December 31, 2019. At December 31, 2021 and 2020, the unamortized customer contract costs were $23 million and $24 million, respectively, and were presented as part of investments and other assets in the accompanying Consolidated Balance Sheets.
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 with Uninsured Patients and other uninsured discount and charity programs. Net operating revenues for our Conifer segment primarily consist of revenues from providing revenue cycle management services to health systems, individual hospitals and physician practices.

The table below shows our sources of net operating revenues less implicit price concessions from continuing operations:
Years Ended December 31,
202120202019
Hospital Operations:
Net patient service revenues from hospitals and related outpatient facilities:
Medicare$2,615 $2,695 $2,888 
Medicaid1,254 1,081 1,193 
Managed care9,985 9,022 9,516 
Uninsured199 162 92 
Indemnity and other706 658 679 
Total14,759 13,618 14,368 
Other revenues(1)
1,223 1,172 1,154 
Hospital Operations total prior to inter-segment eliminations15,982 14,790 15,522 
Ambulatory Care2,718 2,072 2,158 
Conifer1,267 1,306 1,372 
Inter-segment eliminations(482)(528)(573)
Net operating revenues$19,485 $17,640 $18,479 
(1) Primarily physician practices revenues.

Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the years ended December 31, 2021, 2020 and 2019 by $26 million, $6 million and $27 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 table below shows the composition of net operating revenues for our Ambulatory Care segment:
Years Ended December 31,
202120202019
Net patient service revenues
$2,604 $1,960 $2,040 
Management fees86 86 95 
Revenue from other sources28 26 23 
Net operating revenues$2,718 $2,072 $2,158 
The table below shows the composition of net operating revenues for our Conifer segment:
Years Ended December 31,
202120202019
Revenue cycle services – Tenet$467 $514 $556 
Revenue cycle services – other customers705 700 713 
Other services – Tenet15 14 17 
Other services – other customers80 78 86 
Net operating revenues$1,267 $1,306 $1,372 

Other services represented approximately 7% of Conifer’s revenue for the year ended December 31, 2021 and included value‑based care services, consulting services and other client‑defined projects.

Performance Obligations
The following table includes Conifer’s revenue 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, performance incentives, penalties or other variable consideration that is considered constrained. Conifer’s 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
 Total20222023202420252026
Performance obligations$6,181 $606 $606 $552 $552 $552 $3,313 
v3.22.0.1
PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE
 12 Months Ended
Dec. 31, 2021
Property and Professional and General Liablity Insurance [Abstract]  
PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY 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 on an occurrence basis. For the policy period April 1, 2021 through March 31, 2022, 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 and a per‑occurrence sub‑limit of $200 million for named windstorms 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 up to a maximum of $25 million for California earthquakes, $25 million for floods and named windstorms, and 2% of insured values for New Madrid fault earthquakes, with a maximum per‑claim deductible of $25 million. Floods and certain other covered losses, including fires and other perils, have a minimum deductible of $1 million.

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, 2021 and 2020, the aggregate current and long‑term professional and general liability reserves in the accompanying Consolidated Balance Sheets were $1.045 billion and $978 million, respectively. These reserves 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.

All 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 any other material claims applicable to that policy period.

Malpractice expense of $355 million, $320 million and $356 million was included in other operating expenses, net, in the accompanying Consolidated Statements of Operations for the years ended December 31, 2021, 2020 and 2019, respectively, of which $131 million, $120 million and $155 million, respectively, related to adverse claims development for prior years.
v3.22.0.1
CLAIMS AND LAWSUITS
 12 Months Ended
Dec. 31, 2021
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. 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.

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. In cases where we have not disclosed an estimate, we have concluded that the loss is either not reasonably possible or the loss, or a range of loss, is not reasonably estimable, based on available information. Given the inherent uncertainties associated with these matters, especially those involving governmental agencies, and the indeterminate damages sought in some cases, there is significant uncertainty as to the ultimate liability we may incur from these 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.

Government Investigation of Detroit Medical Center
Detroit Medical Center (“DMC”) is subject to an ongoing investigation commenced in October 2017 by the U.S. Attorney’s Office for the Eastern District of Michigan and the Civil Division of the U.S. Department of Justice (“DOJ”) for potential violations of the Stark law, the Medicare and Medicaid anti‑kickback and anti‑fraud and abuse amendments codified under Section 1128B(b) of the Social Security Act, and the federal False Claims Act related to DMC’s employment of nurse practitioners and physician assistants (“Mid‑Level Practitioners”) from 2006 through 2017. As previously disclosed, a media report was published in August 2017 alleging that 14 Mid‑Level Practitioners were terminated by DMC earlier in 2017 due to compliance concerns. On September 28, 2021, the DOJ issued a civil investigative demand to DMC for documents and interrogatories. We are cooperating with the investigation; however, we are unable to determine the potential exposure, if any, at this time.

Other Matters
In July 2019, certain of the entities that purchased the operations of Hahnemann University Hospital and St. Christopher’s Hospital for Children in Philadelphia from us commenced Chapter 11 bankruptcy proceedings. In the three months ended December 31, 2021, we established a reserve of $23 million for certain obligations related to the sale of the hospitals and the subsequent bankruptcy proceedings of the buyers.

We are also subject to claims and lawsuits arising 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 laws, tax audits and other matters. Although the results of these claims and lawsuits cannot be predicted with certainty, we believe that the ultimate resolution of these 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, including lawsuits from patients, employees and others exposed to COVID‑19 at our facilities. 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.
The following table presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs recorded in continuing operations during the years ended December 31, 2021, 2020 and 2019:
 Balances at
Beginning
of Period		Litigation and
Investigation
Costs		Cash
Payments		OtherBalances at
End of
Period
Year Ended December 31, 2021$26 $116 $(59)$(5)$78 
Year Ended December 31, 2020$86 $44 $(108)$4 $26 
Year Ended December 31, 2019$8 $141 $(55)$(8)$86 

During 2021, we also established estimated reserves of $39 million for various employment matters and made settlement payments of $11 million, which are included in the table above.
v3.22.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES
 12 Months Ended
Dec. 31, 2021
Noncontrolling Interest [Abstract]  
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES
We have a put call agreement (the “Baylor Put/Call Agreement”) with Baylor University Medical Center (“Baylor”) that contains put and call options with respect to the 5% ownership interest Baylor holds in USPI. Each year starting in 2021, Baylor may put up to one‑third of its total shares in USPI held as of April 1, 2017 (the “Baylor Shares”) by delivering notice by the end of January of such year. In each year that Baylor does not put the full 33.3% of USPI’s shares allowable, we may call the difference between the number of shares Baylor put and the maximum number of shares it could have put that year. In addition, the Baylor Put/Call Agreement contains a call option pursuant to which we have the ability to acquire all of Baylor’s ownership interest by 2024. We have the ability to choose whether to settle the purchase price for the Baylor put/call, which is mutually agreed‑upon fair market value, in cash or shares of our common stock. Based on the nature of the Baylor Put/Call Agreement, Baylor’s minority interest in USPI was classified as a redeemable noncontrolling interest in the accompanying Consolidated Balance Sheets at December 31, 2021 and 2020.

Baylor did not deliver a put notice to us in January 2021 or January 2022. In February 2021, we notified Baylor of our intention to exercise our call option to purchase 33.3% of the Baylor Shares. We are continuing to negotiate the terms of that purchase. In addition, in February 2022, we notified Baylor of our intention to again exercise our call option to purchase an additional 33.3% of the Baylor Shares.

The following table shows the changes in redeemable noncontrolling interests in equity of consolidated subsidiaries:
 December 31,
 20212020
Balances at beginning of period 
$1,952 $1,506 
Net income336 186 
Distributions paid to noncontrolling interests(217)(135)
Accretion of redeemable noncontrolling interests11 4 
Purchases and sales of businesses and noncontrolling interests, net121 391 
Balances at end of period 
$2,203 $1,952 

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,
 20212020
Hospital Operations$297 $267 
Ambulatory Care1,425 1,273 
Conifer481 412 
Redeemable noncontrolling interests$2,203 $1,952 
 Years Ended December 31,
 202120202019
Hospital Operations$24 $(33)$(37)
Ambulatory Care243 153 159 
Conifer69 66 70 
Net income available to redeemable noncontrolling interests$336 $186 $192 
v3.22.0.1
INCOME TAXES
 12 Months Ended
Dec. 31, 2021
Income Tax Disclosure [Abstract]  
INCOME TAXES INCOME TAXES
The provision for income taxes for continuing operations for the years ended December 31, 2021, 2020 and 2019 consisted of the following:
 Years Ended December 31,
 202120202019
Current tax expense (benefit):   
Federal$50 $— $(6)
State111 30 26 
 161 30 20 
Deferred tax expense (benefit):   
Federal267 (131)140 
State(17)4 — 
 250 (127)140 
 $411 $(97)$160 

A reconciliation between the amount of reported income tax expense (benefit) and the amount computed by multiplying income from continuing operations before income taxes by the statutory federal income tax rate is shown below. State income tax expense for the year ended December 31, 2021 includes $2 million of expense related to the write‑off of expired or worthless unutilized state net operating loss carryforwards and other deferred tax assets for which a full valuation allowance had been provided in prior years. A corresponding tax benefit of $2 million is included for the year ended December 31, 2021 to reflect the reduction in the valuation allowance. Foreign pre-tax loss was $5 million for the year ended December 31, 2021, $13 million for the year ended December 31, 2020, and $6 million for the year ended December 31, 2019.
 Years Ended December 31,
 202120202019
Tax expense at statutory federal rate of 21%$396 $141 $67 
State income taxes, net of federal income tax benefit77 33 21 
Expired state net operating losses, net of federal income tax benefit— 1 2 
Tax benefit attributable to noncontrolling interests(114)(75)(79)
Nondeductible goodwill35 — 4 
Nondeductible executive compensation8 6 6 
Nondeductible litigation costs1 — 7 
Expired charitable contribution carryforward— 1 8 
Stock-based compensation tax deficiencies (benefits)(5)(2)4 
Changes in valuation allowance2 (226)133 
Change in tax contingency reserves, including interest— — (14)
Prior-year provision to return adjustments and other changes in deferred taxes8 14 (3)
Other items3 10 4 
Income tax expense (benefit)$411 $(97)$160 

The COVID Acts included a significant number of tax provisions applicable to individuals and businesses. For businesses, the COVID Acts made changes to the U.S. tax code relating to, among other things: (1) the business interest expense disallowance rules for 2019 and 2020; (2) net operating loss rules; (3) charitable contribution limitations; and (4) the realization of corporate alternative minimum tax credits. As a result of the change in the business interest expense disallowance rules, we recorded an income tax benefit of $88 million during the year ended December 31, 2020 to decrease the valuation allowance for interest expense carryforwards due to the additional deduction of interest expense.

In September 2020, we filed an application with the Internal Revenue Service (“IRS”) to change our method of accounting for certain capitalized costs on our 2019 tax return. This change in tax accounting method resulted in additional interest expense being allowed on the 2019 and 2020 tax returns. We reduced our valuation allowance by an additional $126 million in the year ended December 31, 2020 related to the change in accounting method.
Deferred income taxes reflect the tax effects of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amount used for income tax purposes. The following table discloses those significant components of our deferred tax assets and liabilities, including any valuation allowance:
 December 31, 2021December 31, 2020
 AssetsLiabilitiesAssetsLiabilities
Depreciation and fixed-asset differences$— $532 $— $621 
Reserves related to discontinued operations and restructuring charges2 — 8 — 
Receivables (doubtful accounts and adjustments)215 — 173 — 
Medicare advance payments209 — — — 
Accruals for retained insurance risks234 — 223 — 
Intangible assets— 396 — 385 
Other long-term liabilities23 — 55 — 
Benefit plans242 — 265 — 
Other accrued liabilities56 — 74 — 
Investments and other assets— 92 — 73 
Interest expense limitation10 — 8 — 
Net operating loss carryforwards99 — 566 — 
Stock-based compensation12 — 11 — 
Right-of-use lease assets and obligations208 208 224 224 
Other items48 44 86 39 
 1,358 1,272 1,693 1,342 
Valuation allowance(57)— (55)— 
 $1,301 $1,272 $1,638 $1,342 

Below is a reconciliation of the deferred tax assets and liabilities and the corresponding amounts reported in the accompanying Consolidated Balance Sheets.
 December 31,
 20212020
Deferred income tax assets$65 $325 
Deferred tax liabilities(36)(29)
Net deferred tax asset$29 $296 

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 expected realizability of deferred tax assets. The balance in the valuation allowance as of December 31, 2021 was $57 million. During the year ended December 31, 2020, the valuation allowance decreased by $226 million, including a decrease of $211 million due to limitations on the tax deductibility of interest expense, a decrease of $1 million due to the expiration or worthlessness of unutilized state net operating loss carryovers, and a decrease of $14 million due to changes in expected realizability of deferred tax assets. The remaining balance in the valuation allowance at December 31, 2020 was $55 million. During the year ended December 31, 2019, the valuation allowance increased by $133 million, including an increase of $130 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 $5 million due to changes in expected realizability of deferred tax assets. The remaining balance in the valuation allowance as of December 31, 2019 was $281 million. Deferred tax assets relating to interest expense limitations under Internal Revenue Code Section 163(j) have a full valuation allowance because the interest expense carryovers are not expected to be utilized in the foreseeable future.

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, 2021, 2020 and 2019. 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, 2021, 2020 and 2019.
 Continuing
Operations
Balance At December 31, 2018$45 
Reductions due to a lapse of statute of limitations(14)
Balance At December 31, 2019$31 
Reductions due to a lapse of statute of limitations— 
Balance At December 31, 2020$31 
Increases due to tax positions taken in prior periods3 
Balance At December 31, 2021$34 

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. The total amount of unrecognized tax benefits as of December 31, 2020 was $31 million, of which $29 million, if recognized, would affect our effective tax rate and income tax benefit from continuing operations. In the year ended December 31, 2020, there was no change in our estimated liabilities for uncertain tax positions. The total amount of unrecognized tax benefits as of December 31, 2019 was $31 million, of which $29 million, if recognized, would affect our effective tax rate and income tax expense from continuing operations. Income tax expense in the year ended December 31, 2019 included a benefit of $11 million in continuing operations attributable to a decrease 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. We did not have any interest or penalties on unrecognized tax benefits accrued at December 31, 2021.

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, 2017 remain subject to audit by the IRS.

As of December 31, 2021, 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, 2021, our carryforwards available to offset future taxable income consisted of (1) federal net operating loss (“NOL”) carryforwards of approximately $194 million pre‑tax, $13 million of which expires in 2026 to 2036 and $181 million of which has no expiration date, (2) general business credit carryforwards of approximately $9 million expiring in 2034 through 2038, (3) charitable contribution carryforwards of approximately $90 million expiring in 2024 through 2025 and (4) state NOL carryforwards of approximately $3.333 billion expiring in 2022 through 2041 for which the associated deferred tax benefit, net of valuation allowance and federal tax impact, is $49 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.
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EARNINGS (LOSS) PER COMMON SHARE
 12 Months Ended
Dec. 31, 2021
Earnings Per Share [Abstract]  
EARNINGS (LOSS) PER COMMON SHARE EARNINGS (LOSS) PER COMMON SHARE
The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings (loss) per common share calculations for our continuing operations for the years ended December 31, 2021, 2020 and 2019. Net income available (loss attributable) to our common shareholders is expressed in millions and weighted average shares are expressed in thousands.
 Net Income Available (Loss Attributable) to Common Shareholders (Numerator)Weighted
Average Shares
(Denominator)		Per-Share
Amount
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 
Year Ended December 31, 2020   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$399 105,010 $3.80 
Effect of dilutive stock options, restricted stock units and deferred compensation units— 1,253 (0.05)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$399 106,263 $3.75 
Year Ended December 31, 2019   
Net loss attributable to Tenet Healthcare Corporation common shareholders for basic loss per share$(226)103,398 $(2.19)
Effect of dilutive stock options, restricted stock units and deferred compensation units— — — 
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share$(226)103,398 $(2.19)

All potentially dilutive securities were excluded from the calculation of diluted loss per share for the year ended December 31, 2019 because we did not report income from continuing operations available to common shareholders in that period. In circumstances where we do not have income from continuing operations available to common shareholders, the effect of stock options and other potentially dilutive securities is anti‑dilutive, that is, a loss from continuing operations attributable to common shareholders has the effect of making the diluted loss per share less than the basic loss per share. Had we generated income from continuing operations available to common shareholders in the year ended December 31, 2019, the effect (in thousands) of employee stock options, RSUs and deferred compensation units on the diluted shares calculation would have been an increase in shares of 1,457 for the year ended December 31, 2019.
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FAIR VALUE MEASUREMENTS
 12 Months Ended
Dec. 31, 2021
Fair Value Disclosures [Abstract]  
FAIR VALUE MEASUREMENTS 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 are 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.
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, 2020 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values:
 December 31, 2020Quoted Prices
in Active
Markets for
Identical Assets
(Level 1)		Significant Other
Observable Inputs
(Level 2)		Significant
Unobservable
Inputs
(Level 3)
Long-lived assets held for sale$140 $— $140 $— 
Long-lived assets held and used483 — 483 — 
$623 $— $623 $— 

As discussed in Note 6, we recognized an impairment charge of $76 million to write down buildings in one of our Hospital Operations segment’s markets to their estimated fair value during the year ended December 31, 2020.

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, which include inputs other than quoted prices included in Level 1 that are observable, either directly or indirectly. At December 31, 2021 and 2020, the estimated fair value of our long‑term debt was approximately 103.3% and 104.5%, respectively, of the carrying value of the debt.
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ACQUISITIONS
 12 Months Ended
Dec. 31, 2021
Business Combination and Asset Acquisition [Abstract]  
ACQUISITIONS ACQUISITIONS
In December 2021, subsidiaries of USPI acquired ownership interests in 86 ambulatory surgery centers and related ambulatory support services (collectively, the “2021 SCD Centers”) from Surgical Center Development #3, LLC and Surgical Center Development #4, LLC (“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. The 2021 SCD Centers are included in our Ambulatory Care segment.

In addition to the 2021 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 a controlling interests in three surgical hospitals and two ambulatory surgery centers in which we previously owned a noncontrolling interest for $21 million. All of these facilities are included in our Ambulatory Care segment.

In December 2020, USPI acquired controlling interests in 45 ambulatory surgery centers (collectively, the “2020 SCD Centers”) from SurgCenter Development and physician owners. The fair value of the consideration conveyed for the 2020 SCD Centers was $1.115 billion, consisting of a cash payment of $1.097 billion, fully funded using cash on hand, and the assumption of $18 million of center‑level debt.

In addition to the 2020 SCD Centers, we acquired ownership interests in 10 outpatient businesses (all of which are in our Ambulatory Care segment), and various physician practices during the year ended December 31, 2020. The aggregate purchase price for these acquisitions was $80 million.

During the year ended December 31, 2019, we acquired ownership interests in 10 outpatient businesses (all of which are in our Ambulatory Care segment), three off‑campus emergency departments and various physician practices. The aggregate purchase price for the acquisitions was $25 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 2021, including the 2021 SCD Centers, 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.
Preliminary or final purchase price allocations for all the acquisitions made during the years ended December 31, 2021, 2020 and 2019 are as follows:
Years Ended December 31,
 202120202019
Current assets$59 $67 $16 
Property and equipment88 63 20 
Other intangible assets8 14 4 
Goodwill664 1,581 43 
Other long-term assets, including previously held equity method investments753 38 24 
Current liabilities(25)(45)(16)
Long-term liabilities(70)(43)(35)
Redeemable noncontrolling interests in equity of consolidated subsidiaries(139)(478)(18)
Noncontrolling interests(95)(20)(7)
Cash paid, net of cash acquired(1,220)(1,177)(25)
Gains on consolidations$23 $— $6 

The goodwill generated from these transactions, the majority of which will be deductible for income tax purposes, can be attributed to the benefits that we expect to realize from operating efficiencies and growth strategies. The goodwill total of $664 million from acquisitions completed during the year ended December 31, 2021 was recorded in our Ambulatory Care segment. Approximately $20 million, $14 million and $6 million in transaction costs related to prospective and closed acquisitions were expensed during the years ended December 31, 2021, 2020 and 2019, respectively, and are included in impairment and restructuring charges, and acquisition‑related costs in the accompanying Consolidated Statements of Operations.

During the years ended December 31, 2021 and 2019, we recognized gains totaling $23 million, and $6 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 gains or losses were recognized in the year ended December 31, 2020.

Pro Forma Information - Unaudited
The following table provides certain pro forma information for Tenet as if the 2021 SCD Centers acquisition had occurred at the beginning of the year ended December 31, 2020:
 Year Ended December 31,
 20212020
Net operating revenues$19,627 $17,752 
Equity in earnings of unconsolidated affiliates$258 $192 
Net income available to Tenet Healthcare Corporation common shareholders$941 $416 
Diluted earnings per share available to Tenet Healthcare Corporation
common shareholders
$8.66 $3.92 
v3.22.0.1
SEGMENT INFORMATION
 12 Months Ended
Dec. 31, 2021
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
Our business consists of our Hospital Operations segment, our Ambulatory Care segment and our Conifer segment. 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.

Our Hospital Operations segment is comprised of our acute care and specialty hospitals, imaging centers, ancillary outpatient facilities, micro‑hospitals and physician practices. At December 31, 2021, our subsidiaries operated 60 hospitals serving primarily urban and suburban communities in nine states. 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. In April 2021, we also completed the sale of the majority of the urgent care centers held by our Hospital Operations segment to an unaffiliated urgent care provider. In addition, we completed the sale of the Miami Hospitals in August 2021.
Our Ambulatory Care segment is comprised of the operations of USPI, in which we held an ownership interest of approximately 95% at December 31, 2021 and 2020. At December 31, 2021, USPI had interests in 399 ambulatory surgery centers (249 consolidated) and 24 surgical hospitals (eight consolidated) in 34 states. We completed the divestiture of 40 urgent care centers held by our Ambulatory Care segment on April 1, 2021.

Our Conifer segment provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. At December 31, 2021, Conifer provided services to approximately 650 Tenet and non‑Tenet hospitals and other clients nationwide. In 2012, we entered into an agreement documenting the terms and conditions of various services Conifer provides to Tenet hospitals (“RCM Agreement”), as well as an agreement documenting certain administrative services our Hospital Operations segment provides to Conifer. In March 2021, we entered into a month‑to‑month agreement amending the RCM Agreement effective January 1, 2021 (“Amended RCM Agreement”) to update certain terms and conditions related to the revenue cycle management services Conifer provides to Tenet hospitals. We believe the pricing terms for the services provided under the Amended RCM Agreement are commercially reasonable and consistent with estimated third‑party terms. At December 31, 2021, we owned approximately 76% of Conifer Health Solutions, LLC, which is Conifer’s principal subsidiary.

The following table includes 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:
December 31,
 202120202019
Assets:  
Hospital Operations$17,173 $18,048 $16,196 
Ambulatory Care9,473 8,048 6,195 
Conifer933 1,010 974 
Total 
$27,579 $27,106 $23,365 

 Years Ended December 31,
 202120202019
Capital expenditures:   
Hospital Operations$578 $467 $572 
Ambulatory Care66 51 75 
Conifer14 22 23 
Total 
$658 $540 $670 
Net operating revenues:   
Hospital Operations total prior to inter-segment eliminations$15,982 $14,790 $15,522 
Ambulatory Care2,718 2,072 2,158 
Conifer   
Tenet482 528 573 
Other clients785 778 799 
Total Conifer revenues1,267 1,306 1,372 
Inter-segment eliminations(482)(528)(573)
Total 
$19,485 $17,640 $18,479 
Equity in earnings of unconsolidated affiliates:   
Hospital Operations$25 $6 $15 
Ambulatory Care193 163 160 
Total 
$218 $169 $175 
Adjusted EBITDA:   
Hospital Operations$1,931 $1,911 $1,449 
Ambulatory Care1,197 868 895 
Conifer355 367 386 
Total 
$3,483 $3,146 $2,730 
Years Ended December 31,
202120202019
Depreciation and amortization:
Hospital Operations$722 $739 $733 
Ambulatory Care95 81 72 
Conifer38 37 45 
Total $855 $857 $850 
Adjusted EBITDA $3,483 $3,146 $2,730 
Income (loss) from divested and closed businesses(1)20 (2)
Depreciation and amortization(855)(857)(850)
Impairment and restructuring charges, and acquisition-related costs(85)(290)(185)
Litigation and investigation costs(116)(44)(141)
Interest expense(923)(1,003)(985)
Loss from early extinguishment of debt(74)(316)(227)
Other non-operating income (expense), net14 1 (5)
Net gains (losses) on sales, consolidation and deconsolidation of facilities445 14 (15)
Income from continuing operations, before income taxes$1,888 $671 $320 
v3.22.0.1
RECENT ACCOUNTING STANDARDS
 12 Months Ended
Dec. 31, 2021
Accounting Standards Update and Change in Accounting Principle [Abstract]  
RECENT ACCOUNTING STANDARDS RECENT ACCOUNTING STANDARDS
Recently Issued Accounting Standards
In October 2021, the FASB issued ASU 2021-08, “Business Combinations (Topic 805) – Accounting for Contract Assets and Contract Liabilities from Contracts with Customers” (“ASU 2021-08”). The standard addresses diversity in practice related to the recognition and measurement of contract assets and contract liabilities acquired in a business combination. The guidance requires an acquirer to recognize and measure contract assets and liabilities acquired in a business combination in accordance with Topic 606 – Revenue from Contracts with Customers as if the acquirer had originated the contracts, as opposed to at their fair value on the acquisition date. ASU 2021-08 is effective for us beginning in 2023, with early adoption permitted. We are currently evaluating the impact of this standard to our financial statements.

The FASB issued ASU 2021-10, “Government Assistance (Topic 832)” (“ASU 2021-10”) in November 2021. The amendments in this update require additional disclosures regarding government grants and money contributions, including information on the nature of transactions and related accounting policies used to account for transactions, detail on the line items on the balance sheet and income statement affected by these transactions, and significant terms and conditions of the transactions. ASU 2021-10 is effective for us beginning in 2022, with early adoption permitted. The adoption of this guidance will not impact our financial position, results of operations or cash flows.

In August 2020, the FASB issued ASU 2020-06, “Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity” (ASU 2020-06”). Among other amendments, ASU 2020-06 changes the accounting for diluted earnings-per-share for convertible instruments and contracts that may be settled in cash or stock. Under current GAAP, entities can overcome the presumption of share settlement for convertible instruments and contracts that can be partially or fully settled in cash at the issuer’s election. If successfully rebutted, entities can use the treasury stock method to determine the dilutive effect of these instruments and, under certain conditions, exclude them from diluted weighted average shares outstanding. ASU 2020-06 requires that the if-converted method, which is more dilutive than the treasury stock method, be used for all convertible instruments and eliminates an entity’s ability to assume cash settlement for an instrument that may be share-settled. This standard is effective for the Company in the first quarter of fiscal 2022 and may be applied on a modified or fully retrospective basis. Although the adoption of this guidance will not impact our financial position or cash flows, it may result in an increase in the number of diluted weighted average shares outstanding utilized in our diluted earnings per share calculation.

Recently Adopted Accounting Standards
Effective January 1, 2021, we adopted ASU 2018-14, “Compensation – Retirement Benefits – Defined Benefit Plans –General (Subtopic 715-20) Disclosure Framework – Changes to the Disclosure Requirements for Defined Benefit Plans” (“ASU 2018-14”), which applied to all employers that sponsor defined benefit pension or other postretirement plans. The amendments in ASU 2018-14, removed, modified or added certain disclosure requirements as part of the FASB’s disclosure framework project to improve the effectiveness of the notes to the financial statements. The adoption of this ASU did not impact our financial position, results of operations or cash flows.
Effective January 1, 2020, as further discussed in Note 1, we adopted ASU 2016-13 using the modified retrospective transition approach as of the period of adoption. Also effective January 1, 2020, we adopted ASU 2018-13, “Fair Value Measurement (Topic 820) Disclosure Framework – Changes to the Disclosure Framework Requirements for Fair Value Measurement” (“ASU 2018-13”) using the prescribed transition method and ASU 2018-15, “Intangibles – Goodwill and Other – Internal-Use Software (Subtopic 350-40) Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That is a Service Contract” (“ASU 2018-15”) using the prospective transition method. The adoption of ASU 2018-13 and ASU 2018-15 did not have a material effect on our financial position, results of operations or cash flows.

Effective January 1, 2019, as further discussed in Note 1, we adopted ASU 2016-02 using the modified retrospective transition approach as of the period of adoption.
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SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS
 12 Months Ended
Dec. 31, 2021
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, 2021$55 $2 $— $— $57 
Year ended December 31, 2020$281 $(226)$— $— $55 
Year ended December 31, 2019$148 $133 $— $— $281 
(1)Includes amounts recorded in discontinued operations.
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SUBSEQUENT EVENT
 12 Months Ended
Dec. 31, 2021
Subsequent Events [Abstract]  
SUBSEQUENT EVENT SUBSEQUENT EVENTOn February 9, 2022, we called for the redemption of all $700 million aggregate principal amount outstanding of our 2025 Senior Secured First Lien Notes. We expect to redeem the notes on February 23, 2022 using cash on hand.
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SIGNIFICANT ACCOUNTING POLICIES (Policies)
 12 Months Ended
Dec. 31, 2021
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).

Effective January 1, 2020, we adopted the Financial Accounting Standards Board (“FASB”) Accounting Standards Update (“ASU”) 2016‑13, “Financial Instruments—Credit Losses (Topic 326) Measurement of Credit Losses on Financial Instruments” (“ASU 2016‑13”) using the modified retrospective transition approach as of the period of adoption. The amendments in this ASU required a financial asset (or a group of financial assets) measured at amortized cost basis to be presented at the net amount expected to be collected. The allowance for credit losses is a valuation account that is deducted from the amortized cost basis of the financial asset(s) to present the net carrying value at the amount expected to be collected on the financial asset. Upon adoption of ASU 2016‑13 on January 1, 2020, we recorded a cumulative effect adjustment to increase accumulated deficit by $14 million.

Effective January 1, 2019, we adopted ASU 2016‑02, “Leases (Topic 842)” (“ASU 2016‑02”) using the modified retrospective transition approach as of the period of adoption. Our financial statements for periods prior to January 1, 2019 were not modified for the application of the new lease accounting standard. The main difference between the guidance in ASU 2016‑02 and previous accounting principles generally accepted in the United States of America (“GAAP”) is the recognition of lease assets and lease liabilities on the balance sheet by lessees for those leases classified as operating leases under previous GAAP. Upon adoption of ASU 2016‑02, we recorded $822 million of right‑of‑use assets, net of deferred rent, associated with operating leases in investments and other assets in our consolidated balance sheet, $147 million of current liabilities associated with operating leases in other current liabilities in our consolidated balance sheet and $715 million of long‑term liabilities associated with operating leases in other long‑term liabilities in our consolidated balance sheet. We also recognized $1 million of cumulative effect adjustment that decreased accumulated deficit at January 1, 2019.
Reclassifications Certain prior‑year amounts have been reclassified to conform to the current year presentation. In our consolidated balance sheets, income tax receivable has been reclassified to other current assets, as it is no longer significant enough to present separately. In our consolidated statements of cash flows, long‑term assets has been combined with other items, net, as it is no longer significant enough to present separately, but it remains located within cash flows from investing activities. In addition, within the financing section of our statement of cash flows, proceeds from shares issued under stock‑based compensation plans, net of taxes paid related to net share settlement has been combined with other items, net.
Use of Estimates The preparation of financial statements in conformity with 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. 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 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 We formed our Global Business Center (“GBC”) in the Philippines during the year ended December 31, 2019. 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 operating revenues for our Conifer segment primarily consist of revenues from providing revenue cycle management services to health systems, individual hospitals and physician practices.

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 (“FASB 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 provided to third‑party payers, discounts provided to uninsured patients in accordance with our Compact, and implicit price concessions provided 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 with these classes of patients 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.

Revenues under the traditional fee‑for‑service (“FFS”) Medicare and Medicaid programs are based primarily on prospective payment systems. Retrospectively determined cost‑based revenues under these programs, which were more prevalent in earlier periods, and certain other payments, such as Indirect Medical Education, Direct Graduate Medical Education, disproportionate share hospital and bad debt expense reimbursement, which are based on our hospitals’ cost reports, are estimated using historical trends and current factors. Cost report settlements under these programs are subject to audit by Medicare and Medicaid auditors and administrative and judicial review, and it can take several years until final settlement of such matters is determined and completely resolved. 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.
We have a system and estimation process for recording Medicare net patient service revenue and estimated cost report settlements. As a result, we record accruals to reflect the expected final settlements on our cost reports. For filed cost reports, we record the accrual based on those cost reports and subsequent activity and record a valuation allowance against those cost reports based on historical settlement trends. The accrual 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 as previously described. Cost reports generally must be filed within five months after the end of the annual cost 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.

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. 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.

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. 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 have provided implicit price concessions, primarily 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.

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 Conifer’s 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.

Conifer Revenues—Our Conifer segment recognizes revenue from its contracts when Conifer’s performance obligations are satisfied, which is generally as services are rendered. Revenue is recognized in an amount that reflects the consideration to which Conifer expects to be entitled.

At contract inception, Conifer assesses the services specified in its contracts with customers and identifies a performance obligation for each distinct contracted service. Conifer identifies the performance obligations and considers all the services provided under the contract. Conifer generally considers 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.

Conifer’s contracts generally consist of fixed‑price, volume‑based or contingency‑based fees. Conifer’s long‑term contracts typically provide for Conifer to deliver recurring monthly services over a multi‑year period. The contracts are typically priced such that Conifer’s monthly fee to its 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 Conifer 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 Conifer’s 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.
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 $2.364 billion and $2.446 billion at December 31, 2021 and 2020, respectively. At December 31, 2021 and 2020, our book overdrafts were $226 million and $154 million, respectively, which were classified as accounts payable. At December 31, 2021 and 2020, $188 million and $166 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, 2021, 2020 and 2019, we had $95 million, $93 million and $136 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $88 million, $85 million and $119 million, respectively, were included in accounts payable.
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, 2021, 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) unless we determine that a loss is other‑than‑temporary, at which point we would 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 expense, 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
We control 257 of the facilities within our Ambulatory Care segment and, therefore, consolidate their results. We account for many of the facilities our Ambulatory Care segment operates (166 of 423 at December 31, 2021), 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 years ended December 31, 2021 and 2020, equity in earnings of unconsolidated affiliates included $14 million and $17 million, respectively, from PRF grants recognized by our Ambulatory Care segment’s unconsolidated affiliates.

Summarized financial information for these equity method investees is included in the following table. For investments acquired during the reported periods, amounts reflect 100% of the investee’s results beginning on the date of our acquisition of the investment.
December 31,
 202120202019
Current assets$1,176 $1,309 $1,180 
Noncurrent assets$1,390 $1,262 $1,042 
Current liabilities$(495)$(516)$(372)
Noncurrent liabilities$(855)$(866)$(739)
Noncontrolling interests$(659)$(621)$(579)
 Years Ended December 31,
 202120202019
Net operating revenues$3,030 $2,665 $2,680 
Net income$836 $702 $765 
Net income attributable to the investees$499 $437 $499 

Our equity method investment that contributes the most to our equity in earnings of unconsolidated affiliates is Texas Health Ventures Group, LLC (“THVG”), which is operated by USPI. THVG represented $107 million, $85 million and $79 million of total equity in earnings of unconsolidated affiliates of $218 million, $169 million and $175 million in the years ended December 31, 2021, 2020 and 2019, 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, 2021, 2020 and 2019, capitalized interest was $4 million, $5 million and $11 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 appraisals, established market values of comparable assets or internal 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 appraisals, established market prices for comparable assets or internal estimates of future net cash flows.
Leases
ASU 2016-02 was issued to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. Our adoption of ASU 2016-02 was accomplished using a modified retrospective method of application, and our accounting policies related to leases were revised accordingly effective January 1, 2019, as discussed below.

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 and Conifer segments, 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 (i) expired or existing contracts for whether they are or contain a lease, (ii) the lease classification of any existing leases or (iii) 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. For goodwill, we perform the test at the reporting unit level when events occur that require an evaluation to be performed or at least annually. 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 appraisals, established market prices for comparable assets or internal 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, when they are probable and can be reasonably estimated. The accrual, which includes an estimate of incurred but not reported claims, is updated each quarter based on a model of projected payments using case‑specific facts and circumstances and our historical loss reporting, development and settlement patterns. To the extent that subsequent claims information varies from our estimates, the liability is adjusted in the period such information becomes available. Malpractice expense is presented within other operating expenses in the accompanying 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 We primarily operate acute care hospitals and related healthcare facilities. Our Hospital Operations segment generated 80% of our net operating revenues in the year ended December 31, 2021 and 81% during both of the years ended December 31, 2020 and 2019. At December 31, 2021, each of our markets related to our general hospitals reported directly to our chief executive officer. 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
Recently Issued Accounting Standards
In October 2021, the FASB issued ASU 2021-08, “Business Combinations (Topic 805) – Accounting for Contract Assets and Contract Liabilities from Contracts with Customers” (“ASU 2021-08”). The standard addresses diversity in practice related to the recognition and measurement of contract assets and contract liabilities acquired in a business combination. The guidance requires an acquirer to recognize and measure contract assets and liabilities acquired in a business combination in accordance with Topic 606 – Revenue from Contracts with Customers as if the acquirer had originated the contracts, as opposed to at their fair value on the acquisition date. ASU 2021-08 is effective for us beginning in 2023, with early adoption permitted. We are currently evaluating the impact of this standard to our financial statements.

The FASB issued ASU 2021-10, “Government Assistance (Topic 832)” (“ASU 2021-10”) in November 2021. The amendments in this update require additional disclosures regarding government grants and money contributions, including information on the nature of transactions and related accounting policies used to account for transactions, detail on the line items on the balance sheet and income statement affected by these transactions, and significant terms and conditions of the transactions. ASU 2021-10 is effective for us beginning in 2022, with early adoption permitted. The adoption of this guidance will not impact our financial position, results of operations or cash flows.

In August 2020, the FASB issued ASU 2020-06, “Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity” (ASU 2020-06”). Among other amendments, ASU 2020-06 changes the accounting for diluted earnings-per-share for convertible instruments and contracts that may be settled in cash or stock. Under current GAAP, entities can overcome the presumption of share settlement for convertible instruments and contracts that can be partially or fully settled in cash at the issuer’s election. If successfully rebutted, entities can use the treasury stock method to determine the dilutive effect of these instruments and, under certain conditions, exclude them from diluted weighted average shares outstanding. ASU 2020-06 requires that the if-converted method, which is more dilutive than the treasury stock method, be used for all convertible instruments and eliminates an entity’s ability to assume cash settlement for an instrument that may be share-settled. This standard is effective for the Company in the first quarter of fiscal 2022 and may be applied on a modified or fully retrospective basis. Although the adoption of this guidance will not impact our financial position or cash flows, it may result in an increase in the number of diluted weighted average shares outstanding utilized in our diluted earnings per share calculation.

Recently Adopted Accounting Standards
Effective January 1, 2021, we adopted ASU 2018-14, “Compensation – Retirement Benefits – Defined Benefit Plans –General (Subtopic 715-20) Disclosure Framework – Changes to the Disclosure Requirements for Defined Benefit Plans” (“ASU 2018-14”), which applied to all employers that sponsor defined benefit pension or other postretirement plans. The amendments in ASU 2018-14, removed, modified or added certain disclosure requirements as part of the FASB’s disclosure framework project to improve the effectiveness of the notes to the financial statements. The adoption of this ASU did not impact our financial position, results of operations or cash flows.
Effective January 1, 2020, as further discussed in Note 1, we adopted ASU 2016-13 using the modified retrospective transition approach as of the period of adoption. Also effective January 1, 2020, we adopted ASU 2018-13, “Fair Value Measurement (Topic 820) Disclosure Framework – Changes to the Disclosure Framework Requirements for Fair Value Measurement” (“ASU 2018-13”) using the prescribed transition method and ASU 2018-15, “Intangibles – Goodwill and Other – Internal-Use Software (Subtopic 350-40) Customer’s Accounting for Implementation Costs Incurred in a Cloud Computing Arrangement That is a Service Contract” (“ASU 2018-15”) using the prospective transition method. The adoption of ASU 2018-13 and ASU 2018-15 did not have a material effect on our financial position, results of operations or cash flows.

Effective January 1, 2019, as further discussed in Note 1, we adopted ASU 2016-02 using the modified retrospective transition approach as of the period of adoption.
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SIGNIFICANT ACCOUNTING POLICIES (Tables)
 12 Months Ended
Dec. 31, 2021
Accounting Policies [Abstract]  
Summarizes Grant Funds Received And Grant Income
The table below summarizes grant funds received by our Hospital Operations and Ambulatory Care segments and by our unconsolidated affiliates for which we provide cash management services during the years ended December 31, 2021 and 2020, and their location in the accompanying Consolidated Statements of Cash Flows. There was no grant fund activity during the year ended December 31, 2019.
Years Ended December 31,
20212020
Grant payments received from COVID-19 relief programs:
Included in cash flows from operating activities:
Hospital Operations$142 $824 
Ambulatory Care36 76 
$178 $900 
Included in cash flows from financing activities:
Unconsolidated affiliates for which we provide cash management services$37 $74 
The table below summarizes grant income recognized by our Hospital Operations and Ambulatory Care segments during the years ended December 31, 2021 and 2020. In addition, the table presents grant income recognized by our unconsolidated affiliates during 2021 and 2020, which is included in equity in earnings of unconsolidated affiliates in our consolidated statement of operations. No grant income was recognized during the year ended December 31, 2019.
Years Ended December 31,
20212020
Grant income recognized from COVID-19 relief programs:
Included in grant income:
Hospital Operations$142 $823 
Ambulatory Care49 59 
$191 $882 
 Included in equity in earnings of unconsolidated affiliates:
Unconsolidated affiliates$14 $17 
Schedule of Equity Method Investments For investments acquired during the reported periods, amounts reflect 100% of the investee’s results beginning on the date of our acquisition of the investment.
December 31,
 202120202019
Current assets$1,176 $1,309 $1,180 
Noncurrent assets$1,390 $1,262 $1,042 
Current liabilities$(495)$(516)$(372)
Noncurrent liabilities$(855)$(866)$(739)
Noncontrolling interests$(659)$(621)$(579)
 Years Ended December 31,
 202120202019
Net operating revenues$3,030 $2,665 $2,680 
Net income$836 $702 $765 
Net income attributable to the investees$499 $437 $499 
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ACCOUNTS RECEIVABLE (Tables)
 12 Months Ended
Dec. 31, 2021
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,
 20212020
Continuing operations:  
Patient accounts receivable$2,600 $2,499 
Estimated future recoveries137 156 
Net cost reports and settlements receivable and valuation allowances33 34 
 2,770 2,689 
Discontinued operations— 1 
Accounts receivable, net 
$2,770 $2,690 
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,
 20212020
Assets:
Other current assets$370 $378 
Investments and other assets$213 $206 
Liabilities:
Other current liabilities$123 $110 
Other long-term liabilities$60 $56 
Schedule of Estimated Costs for Charity Care and Self-Pay Patients
The following table shows our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses and which exclude the costs of our now-divested health plan businesses) of caring for our uninsured and charity patients:
 Years Ended December 31,
 202120202019
Estimated costs for:   
Uninsured patients$650 $617 $664 
Charity care patients97 147 156 
Total $747 $764 $820 
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CONTRACT BALANCES (Tables)
 12 Months Ended
Dec. 31, 2021
Revenue from Contract with Customer [Abstract]  
Opening and Closing Balances of Contracts Assets and Liabilities
The opening and closing balances of contract assets and contract liabilities for our Hospital Operations segment were as follows:
Contract Liability –Contract Liability –
CurrentLong-term
Contract AssetsAdvances from MedicareAdvances from Medicare
December 31, 2020$208 $510 $819 
December 31, 2021181 876 — 
Increase (decrease)$(27)$366 $(819)
December 31, 2019$170 $— $— 
December 31, 2020208 510 819 
Increase$38 $510 $819 
The opening and closing balances of contract liabilities for our Ambulatory Care segment were as follows:
Contract Liability –Contract Liability –
CurrentLong-term
Advances from MedicareAdvances from Medicare
December 31, 2020$93 $83 
December 31, 20214 — 
Decrease$(89)$(83)
December 31, 2019$— $— 
December 31, 202093 83 
Increase$93 $83 
The opening and closing balances of Conifer’s receivables, contract asset, and current and long‑term contract liabilities were as follows:
Contract Liability –Contract Liability –
Contract Asset –CurrentLong-Term
ReceivablesUnbilled RevenueDeferred RevenueDeferred Revenue
December 31, 2020$56 $20 $56 $16 
December 31, 202128 18 79 15 
Increase (decrease)$(28)$(2)$23 $(1)
December 31, 2019$26 $11 $61 $18 
December 31, 202056 20 56 16 
Increase (decrease)$30 $9 $(5)$(2)
v3.22.0.1
ASSETS AND LIABILITIES HELD FOR SALE (Tables)
 12 Months Ended
Dec. 31, 2021
Discontinued Operations and Disposal Groups [Abstract]  
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
The following table provides information on significant components of our business that were recently disposed of:
 Years Ended December 31,
 202120202019
Significant disposals:  
Income (loss) from continuing operations, before income taxes:
Chicago-area hospitals (includes a $5 million loss on sale in the 2020 period and a $14 million loss on sale in the 2019 period)
$(2)$3 $(19)
Miami Hospitals (includes a $406 million gain on sale in 2021)
455 67 44 
Total$453 $70 $25 
v3.22.0.1
LEASES (Tables)
 12 Months Ended
Dec. 31, 2021
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 at:
December 31,
Component of Lease BalancesClassification in Consolidated Balance Sheet20212020
Assets:  
Operating lease assetsInvestments and other assets$1,002 $1,062 
Finance lease assets
Property and equipment, at cost, less
accumulated depreciation and amortization
333 345 
Total leased assets$1,335 $1,407 
Liabilities:
Operating lease liabilities:
CurrentOther current liabilities$201 $188 
Long-termOther long-term liabilities924 999 
Total operating lease liabilities1,125 1,187 
Finance lease liabilities:
CurrentCurrent portion of long-term debt106 122 
Long-termLong-term debt, net of current portion176 151 
Total finance lease liabilities282 273 
Total lease liabilities$1,407 $1,460 
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,
202120202019
Operating lease expenseOther operating expenses, net$241 $247 $211 
Finance lease expense:
Amortization of leased assetsDepreciation and amortization71 86 85 
Interest on lease liabilitiesInterest expense9 11 15 
Total finance lease expense80 97 100 
Variable and short term-lease expenseOther operating expenses, net171 156 133 
Total lease expense$492 $500 $444 

The weighted‑average lease terms and discount rates for operating and finance leases are presented in the following table:
Years Ended December 31,
202120202019
Weighted-average remaining lease term (years):
Operating leases7.57.97.8
Finance leases5.75.75.4
Weighted-average discount rate:
Operating leases5.1 %5.5 %5.6 %
Finance leases5.4 %5.6 %5.5 %
Cash flow and other information related to leases is included in the following table:
Years Ended December 31,
202120202019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases$237 $239 $197 
Operating cash outflows from finance leases$12 $15 $18 
Financing cash outflows from finance leases$140 $154 $151 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases$176 $304 $249 
Finance leases$136 $98 $141 
Operating Lease Liability Maturity Schedule
Future maturities of lease liabilities at December 31, 2021 are presented in the following table:
Operating LeasesFinance LeasesTotal
2022$236 $116 $352 
2023211 76 287 
2024185 48 233 
2025156 16 172 
2026124 11 135 
Later years456 83 539 
Total lease payments1,368 350 1,718 
Less: Imputed interest243 68 311 
Total lease obligations1,125 282 1,407 
Less: Current obligations201 106 307 
Long-term lease obligations$924 $176 $1,100 
Finance Lease Liability Maturity Schedule
Future maturities of lease liabilities at December 31, 2021 are presented in the following table:
Operating LeasesFinance LeasesTotal
2022$236 $116 $352 
2023211 76 287 
2024185 48 233 
2025156 16 172 
2026124 11 135 
Later years456 83 539 
Total lease payments1,368 350 1,718 
Less: Imputed interest243 68 311 
Total lease obligations1,125 282 1,407 
Less: Current obligations201 106 307 
Long-term lease obligations$924 $176 $1,100 
v3.22.0.1
LONG-TERM DEBT (Tables)
 12 Months Ended
Dec. 31, 2021
Long-term Debt and Lease Obligation [Abstract]  
Summary of Long-Term Debt
The table below shows our long‑term debt included in the accompanying Consolidated Balance Sheets:
December 31,
 20212020
Senior unsecured notes:  
6.750% due 2023
$1,872 $1,872 
7.000% due 2025
— 478 
6.125% due 2028
2,500 2,500 
6.875% due 2031
362 362 
Senior secured first lien notes:  
4.625% due 2024
770 1,870 
4.625% due 2024
600 600 
7.500% due 2025
700 700 
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 — 
4.375% due 2030
1,450 — 
Senior secured second lien notes:
5.125% due 2025
— 1,410 
6.250% due 2027
1,500 1,500 
Finance leases, mortgage and other notes443 403 
Unamortized issue costs and note discounts(151)(176)
Total long-term debt15,646 15,719 
Less current portion135 145 
Long-term debt, net of current portion$15,511 $15,574 
Schedule of Future Long Term Debt Maturities and Minimum Operating Lease Payments
Future long‑term debt maturities, including finance lease obligations were as follows as of December 31, 2021:
  Years Ending December 31,Later Years
 Total20222023202420252026
Long-term debt, including finance lease obligations$15,797 $135 $1,983 $1,446 $742 $2,120 $9,371 
v3.22.0.1
EMPLOYEE BENEFIT PLANS (Tables)
 12 Months Ended
Dec. 31, 2021
Share-based Payment Arrangement [Abstract]  
Schedule of Information Related to Stock-Based Awards by Grant Date
The table below shows certain stock option and RSU grants and other awards, net of forfeitures, that comprise the stock‑based compensation expense recorded in the year ended December 31, 2021. 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.
Grant DateAwardsExercise Price
Per Share		Fair Value
Per Share at
Grant Date
Stock-Based
Compensation Expense for Year Ended December 31, 2021
 (In Thousands)  (In Millions)
Stock options:
February 27, 2019188 $28.26 $12.49 $1 
Restricted stock units:    
May 7, 202137 $47.99 2 
February 24, 2021585 $52.85 12 
February 26, 20201,221 $27.80 15 
February 27, 2019790 $28.26 5 
January 31, 2019318 $21.99 2 
Other grants(1)
661 $30.73 6 
Other stock-based compensation plans:
USPI management equity plan1,883  $34.13 13 
    $56 
(1)
Per-share value presented is the weighted-average grant date fair value of the grants included. Grant dates range from June 2016 to September 2021 with per‑share grant date fair values ranging from $18.11 to $74.99.
Summary of Stock Option Activity
The following table summarizes stock option activity during the years ended December 31, 2021, 2020 and 2019:
 OptionsWtd. Avg.
Exercise Price
Per Share		Aggregate
Intrinsic Value		Wtd. Avg
Remaining Life
   (In Millions) 
Outstanding at December 31, 2018
2,262,743 $19.12   
Granted230,713 $28.28   
Exercised(306,427)$18.05   
Forfeited/Expired(226,037)$20.21   
Outstanding at December 31, 2019
1,960,992 $20.24   
Exercised(987,471)$17.96   
Forfeited/Expired(60,990)$23.28   
Outstanding at December 31, 2020
912,531 $22.51   
Exercised(391,533)$20.66   
Outstanding at December 31, 2021
520,998 $23.90 $30 6.2 years
Vested and expected to vest at December 31, 2021
520,998 $23.90 $30 6.2 years
Exercisable at December 31, 2021
324,980 $21.25 $20 5.7 years
Summary of Information About Stock Options by Range of Exercise Prices
The following table summarizes information about our outstanding stock options at December 31, 2021:
 Options OutstandingOptions Exercisable
Range of Exercise Prices Number of
Options		Wtd. Avg.
Remaining
Contractual Life		Wtd. Avg.
Exercise Price		Number of
Options		Wtd. Avg.
Exercise Price
$18.99 to $20.609
293,796 5.6 years$19.75 293,796 $19.75 
$20.61 to $35.430
227,202 6.9 years29.26 31,184 35.43 
 520,998 6.2 years$23.90 324,980 $21.25 
Schedule of Stock Options by Monetary Status and Employment Status of the Awardees
As of December 31, 2021, 57.0% of all our outstanding options were held by current employees and 43.0% were held by former employees. Of our outstanding options, 100% were in‑the‑money, that is, they had exercise price less than the $81.69 market price of our common stock on December 31, 2021.
 In-the-Money OptionsOut-of-the-Money OptionsAll Options
 Outstanding% of TotalOutstanding% of TotalOutstanding% of Total
Current employees296,916 57.0 %— — %296,916 57.0 %
Former employees224,082 43.0 %— — %224,082 43.0 %
Totals520,998 100.0 %— — 520,998 100.0 %
% of all outstanding options100.0 % — % 100.0 % 
Summary of Restricted Stock Unit Activity
The following table summarizes RSU activity during the years ended December 31, 2021, 2020 and 2019:
 Restricted Stock UnitsWtd. Avg. Grant Date Fair Value Per Unit
Unvested at December 31, 2018
1,884,130 $32.25 
Granted1,481,021 $27.87 
Vested(1,562,191)$36.45 
Forfeited(339,461)$24.74 
Unvested at December 31, 2019
1,463,499 $25.08 
Granted1,767,730 $27.72 
Vested(825,727)$25.66 
Forfeited(310,296)$32.09 
Unvested at December 31, 2020
2,095,206 $25.87 
Granted900,018 $58.61 
Vested(765,814)$30.51 
Forfeited(58,208)$37.60 
Unvested at December 31, 2021
2,171,202 $40.51 
The following table summarizes RSU activity under USPI’s management equity plan during the year ended December 31, 2021 and 2020:
Number of
Restricted Stock Units		Wtd. Avg. Grant
Date Fair Value Per Unit
Inception of Plan
Granted2,556,353 $34.13 
Forfeited(531,297)$34.13 
Unvested at December 31, 2020
2,025,056 $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 
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,
20212020
Expected volatility
65.2% - 79.3%
54.7 %
Risk-free interest rate
0.1% - 0.6%
1.2 %
Schedule of Employee Stock Purchase Plan Activity
We issued the following numbers of shares under our employee stock purchase plan:
 Years Ended December 31, 
 202120202019
Number of shares89,865 254,767 215,422 
Weighted average price$63.01 $19.97 $24.44 
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,
 20212020
Reconciliation of funded status of plans and the amounts included in the Consolidated Balance Sheets:  
Projected benefit obligations(1)
  
Beginning obligations$(1,429)$(1,369)
Interest cost(36)(47)
Actuarial gain (loss)42 (92)
Benefits paid110 79 
Ending obligations(1,313)(1,429)
Fair value of plans assets  
Beginning plan assets869 790 
Gain on plan assets62 98 
Employer contribution22 38 
Benefits paid(86)(57)
Ending plan assets867 869 
Funded status of plans$(446)$(560)
(1)The accumulated benefit obligation at December 31, 2021 and 2020 was approximately $1.311 billion and $1.426 billion, respectively.

 December 31,
 20212020
Amounts recognized in the Consolidated Balance Sheets consist of:  
Other current liability$(25)$(63)
Other long-term liability$(421)$(497)
Accumulated other comprehensive loss$294 $355 
SERP Assumptions:  
Discount rate3.00 %2.75 %
Compensation increase rate3.00 %3.00 %
Measurement dateDecember 31, 2021December 31, 2020
DMC Pension Plan Assumptions:  
Discount rate2.89 %2.53 %
Compensation increase rateFrozenFrozen
Measurement dateDecember 31, 2021December 31, 2020
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,
 202120202019
Interest costs$36 $47 $58 
Expected return on plan assets(53)(48)(46)
Amortization of net actuarial loss11 9 10 
Special termination benefit costs— — 1 
Net periodic benefit cost (income)$(6)$8 $23 
SERP Assumptions:   
Discount rate2.75 %3.50 %4.50 %
Compensation increase rate3.00 %3.00 %3.00 %
Measurement dateJanuary 1, 2021January 1, 2020January 1, 2019
Census dateJanuary 1, 2021January 1, 2020January 1, 2019
DMC Pension Plan Assumptions:   
Discount rate2.53 %3.60 %4.62 %
Long-term rate of return on assets6.25 %6.25 %6.50 %
Compensation increase rateFrozenFrozenFrozen
Measurement dateJanuary 1, 2021January 1, 2020January 1, 2019
Census dateJanuary 1, 2021January 1, 2020January 1, 2019
Schedule of Weighted-Average Asset Allocations by Asset Category The weighted‑average asset allocations by asset category as of December 31, 2021, were as follows:
Asset CategoryTargetActual
Cash and cash equivalents— %1 %
Equity securities32 %28 %
Debt securities58 %59 %
Alternative investments11 %11 %
Summary 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, 2021 and 2020, aggregated by the level in the fair value hierarchy within which those measurements are determined. 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 are unobservable data points for the asset or liability, and include situations where there is little, if any, market activity for the asset or liability.
 December 31, 2021Level 1Level 2Level 3
Cash and cash equivalents$11 $11 $— $— 
Equity securities242 242 — — 
Debt Securities:
U.S. government obligations67 67 — — 
Corporate debt securities448 448 — — 
Alternative investments:
Private equity securities57 — — 57 
Real estate securities16 16 — — 
Hedge funds26 — — 26 
 $867 $784 $— $83 

 December 31, 2020Level 1Level 2Level 3
Cash and cash equivalents$44 $44 $— $— 
Equity securities484 484 — — 
Debt Securities:
U.S. government obligations76 76 — — 
Corporate debt securities240 240 — — 
Alternative investments:
Private equity securities8 — — 8 
Hedge funds17 — 17 — 
 $869 $844 $17 $8 
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
 Total20222023202420252026
Estimated benefit payments$828 $83 $84 $85 $85 $85 $406 
v3.22.0.1
PROPERTY AND EQUIPMENT (Tables)
 12 Months Ended
Dec. 31, 2021
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,
 20212020
Land$635 $612 
Buildings and improvements6,652 6,985 
Construction in progress166 33 
Equipment4,455 4,593 
Finance lease assets479 512 
 12,387 12,735 
Accumulated depreciation and amortization(5,960)(6,043)
Net property and equipment$6,427 $6,692 
v3.22.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS (Tables)
 12 Months Ended
Dec. 31, 2021
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, which was included in the accompanying Consolidated Balance Sheets:
December 31,
 20212020
Hospital Operations  
Goodwill at beginning of period:  
Goodwill$5,375 $5,338 
Accumulated impairment losses(2,430)(2,430)
2,945 2,908 
Goodwill transferred from Ambulatory Care segment41 — 
Goodwill related to assets held for sale and disposed(178)37 
Goodwill at end of period$2,808 $2,945 
Goodwill at end of period:  
Goodwill$5,238 $5,375 
Accumulated impairment losses(2,430)(2,430)
Goodwill at end of period$2,808 $2,945 
Ambulatory Care
Goodwill at beginning of period$5,258 $3,739 
Goodwill acquired during the year and purchase price allocation adjustments664 1,581 
Goodwill transferred to Hospital Operations segment(41)— 
Goodwill related to assets held for sale and disposed or deconsolidated facilities(33)(62)
Goodwill at end of period$5,848 $5,258 
Conifer
Goodwill at beginning of period$605 $605 
Goodwill acquired during the year and purchase price allocation adjustments— — 
Goodwill related to assets held for sale and disposed or deconsolidated facilities— — 
Goodwill at end of period$605 $605 
Schedule of Other Intangible Assets
The following table provides information regarding other intangible assets, which were included in the accompanying Consolidated Balance Sheets as of December 31, 2021 and 2020:
 Gross
Carrying
Amount		Accumulated
Amortization		Net Book
Value
At December 31, 2021:   
Capitalized software costs$1,770 $(1,165)$605 
Trade names102 — 102 
Contracts897 (128)769 
Other102 (81)21 
Total$2,871 $(1,374)$1,497 
At December 31, 2020:   
Capitalized software costs$1,800 $(1,084)$716 
Trade names102 — 102 
Contracts872 (111)761 
Other110 (89)21 
Total$2,884 $(1,284)$1,600 
Schedule of Estimated Future Amortization of Intangibles with Finite Useful Lives
Estimated future amortization of intangibles with finite useful lives as of December 31, 2021 was as follows:
 TotalYears Ending December 31,Later Years
 20222023202420252026
Amortization of intangible assets$786 $147 $119 $108 $94 $73 $245 
v3.22.0.1
INVESTMENTS AND OTHER ASSETS (Tables)
 12 Months Ended
Dec. 31, 2021
Investments, Debt and Equity Securities [Abstract]  
Schedule of Investments and Other Assets
The principal components of investments and other assets in the accompanying Consolidated Balance Sheets are as follows:
 December 31,
 20212020
Marketable securities$9 $3 
Equity investments in unconsolidated healthcare entities1,806 1,024 
Total investments1,815 1,027 
Cash surrender value of life insurance policies47 42 
Long-term deposits57 67 
California provider fee program receivables213 206 
Operating lease assets1,002 1,062 
Land held for expansion, other long-term receivables and other assets120 130 
Investments and other assets$3,254 $2,534 
v3.22.0.1
ACCUMULATED OTHER COMPREHENSIVE LOSS (Tables)
 12 Months Ended
Dec. 31, 2021
Accumulated Other Comprehensive Income (Loss), Net of Tax [Abstract]  
Schedule of Accumulated Other Comprehensive Loss
Our accumulated other comprehensive loss is comprised of the following:
 December 31,
 20212020
Adjustments for defined benefit plans$(232)$(281)
Foreign currency translation adjustments and other(1)— 
Accumulated other comprehensive loss$(233)$(281)
v3.22.0.1
NET OPERATING REVENUES - (Tables)
 12 Months Ended
Dec. 31, 2021
Revenue from Contract with Customer [Abstract]  
Sources of Net Operating Revenues Less Provisions for Doubtful Accounts and Implicit Price Concessions
The table below shows our sources of net operating revenues less implicit price concessions from continuing operations:
Years Ended December 31,
202120202019
Hospital Operations:
Net patient service revenues from hospitals and related outpatient facilities:
Medicare$2,615 $2,695 $2,888 
Medicaid1,254 1,081 1,193 
Managed care9,985 9,022 9,516 
Uninsured199 162 92 
Indemnity and other706 658 679 
Total14,759 13,618 14,368 
Other revenues(1)
1,223 1,172 1,154 
Hospital Operations total prior to inter-segment eliminations15,982 14,790 15,522 
Ambulatory Care2,718 2,072 2,158 
Conifer1,267 1,306 1,372 
Inter-segment eliminations(482)(528)(573)
Net operating revenues$19,485 $17,640 $18,479 
(1) Primarily physician practices revenues.
The table below shows the composition of net operating revenues for our Ambulatory Care segment:
Years Ended December 31,
202120202019
Net patient service revenues
$2,604 $1,960 $2,040 
Management fees86 86 95 
Revenue from other sources28 26 23 
Net operating revenues$2,718 $2,072 $2,158 
The table below shows the composition of net operating revenues for our Conifer segment:
Years Ended December 31,
202120202019
Revenue cycle services – Tenet$467 $514 $556 
Revenue cycle services – other customers705 700 713 
Other services – Tenet15 14 17 
Other services – other customers80 78 86 
Net operating revenues$1,267 $1,306 $1,372 
Revenue Expected to be Recognized in the Future Related to Performance Obligations
The following table includes Conifer’s revenue 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, performance incentives, penalties or other variable consideration that is considered constrained. Conifer’s 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
 Total20222023202420252026
Performance obligations$6,181 $606 $606 $552 $552 $552 $3,313 
v3.22.0.1
CLAIMS AND LAWSUITS (Tables)
 12 Months Ended
Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]  
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 recorded in continuing operations during the years ended December 31, 2021, 2020 and 2019:
 Balances at
Beginning
of Period		Litigation and
Investigation
Costs		Cash
Payments		OtherBalances at
End of
Period
Year Ended December 31, 2021$26 $116 $(59)$(5)$78 
Year Ended December 31, 2020$86 $44 $(108)$4 $26 
Year Ended December 31, 2019$8 $141 $(55)$(8)$86 
v3.22.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES (Tables)
 12 Months Ended
Dec. 31, 2021
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,
 20212020
Balances at beginning of period 
$1,952 $1,506 
Net income336 186 
Distributions paid to noncontrolling interests(217)(135)
Accretion of redeemable noncontrolling interests11 4 
Purchases and sales of businesses and noncontrolling interests, net121 391 
Balances at end of period 
$2,203 $1,952 

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,
 20212020
Hospital Operations$297 $267 
Ambulatory Care1,425 1,273 
Conifer481 412 
Redeemable noncontrolling interests$2,203 $1,952 
 Years Ended December 31,
 202120202019
Hospital Operations$24 $(33)$(37)
Ambulatory Care243 153 159 
Conifer69 66 70 
Net income available to redeemable noncontrolling interests$336 $186 $192 
v3.22.0.1
INCOME TAXES (Tables)
 12 Months Ended
Dec. 31, 2021
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, 2021, 2020 and 2019 consisted of the following:
 Years Ended December 31,
 202120202019
Current tax expense (benefit):   
Federal$50 $— $(6)
State111 30 26 
 161 30 20 
Deferred tax expense (benefit):   
Federal267 (131)140 
State(17)4 — 
 250 (127)140 
 $411 $(97)$160 
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 (benefit) and the amount computed by multiplying income from continuing operations before income taxes by the statutory federal income tax rate is shown below. State income tax expense for the year ended December 31, 2021 includes $2 million of expense related to the write‑off of expired or worthless unutilized state net operating loss carryforwards and other deferred tax assets for which a full valuation allowance had been provided in prior years. A corresponding tax benefit of $2 million is included for the year ended December 31, 2021 to reflect the reduction in the valuation allowance. Foreign pre-tax loss was $5 million for the year ended December 31, 2021, $13 million for the year ended December 31, 2020, and $6 million for the year ended December 31, 2019.
 Years Ended December 31,
 202120202019
Tax expense at statutory federal rate of 21%$396 $141 $67 
State income taxes, net of federal income tax benefit77 33 21 
Expired state net operating losses, net of federal income tax benefit— 1 2 
Tax benefit attributable to noncontrolling interests(114)(75)(79)
Nondeductible goodwill35 — 4 
Nondeductible executive compensation8 6 6 
Nondeductible litigation costs1 — 7 
Expired charitable contribution carryforward— 1 8 
Stock-based compensation tax deficiencies (benefits)(5)(2)4 
Changes in valuation allowance2 (226)133 
Change in tax contingency reserves, including interest— — (14)
Prior-year provision to return adjustments and other changes in deferred taxes8 14 (3)
Other items3 10 4 
Income tax expense (benefit)$411 $(97)$160 
Schedule of Components of Deferred Tax Assets and Liabilities, Including Any Valuation Allowance The following table discloses those significant components of our deferred tax assets and liabilities, including any valuation allowance:
 December 31, 2021December 31, 2020
 AssetsLiabilitiesAssetsLiabilities
Depreciation and fixed-asset differences$— $532 $— $621 
Reserves related to discontinued operations and restructuring charges2 — 8 — 
Receivables (doubtful accounts and adjustments)215 — 173 — 
Medicare advance payments209 — — — 
Accruals for retained insurance risks234 — 223 — 
Intangible assets— 396 — 385 
Other long-term liabilities23 — 55 — 
Benefit plans242 — 265 — 
Other accrued liabilities56 — 74 — 
Investments and other assets— 92 — 73 
Interest expense limitation10 — 8 — 
Net operating loss carryforwards99 — 566 — 
Stock-based compensation12 — 11 — 
Right-of-use lease assets and obligations208 208 224 224 
Other items48 44 86 39 
 1,358 1,272 1,693 1,342 
Valuation allowance(57)— (55)— 
 $1,301 $1,272 $1,638 $1,342 
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,
 20212020
Deferred income tax assets$65 $325 
Deferred tax liabilities(36)(29)
Net deferred tax asset$29 $296 
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, 2021, 2020 and 2019. 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, 2021, 2020 and 2019.
 Continuing
Operations
Balance At December 31, 2018$45 
Reductions due to a lapse of statute of limitations(14)
Balance At December 31, 2019$31 
Reductions due to a lapse of statute of limitations— 
Balance At December 31, 2020$31 
Increases due to tax positions taken in prior periods3 
Balance At December 31, 2021$34 
v3.22.0.1
EARNINGS (LOSS) PER COMMON SHARE (Tables)
 12 Months Ended
Dec. 31, 2021
Earnings Per Share [Abstract]  
Schedule of Reconciliation of Numerators and Denominators of our Basic and Diluted Earnings (Loss) Per Common Share
The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings (loss) per common share calculations for our continuing operations for the years ended December 31, 2021, 2020 and 2019. Net income available (loss attributable) to our common shareholders is expressed in millions and weighted average shares are expressed in thousands.
 Net Income Available (Loss Attributable) to Common Shareholders (Numerator)Weighted
Average Shares
(Denominator)		Per-Share
Amount
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 
Year Ended December 31, 2020   
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share$399 105,010 $3.80 
Effect of dilutive stock options, restricted stock units and deferred compensation units— 1,253 (0.05)
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share$399 106,263 $3.75 
Year Ended December 31, 2019   
Net loss attributable to Tenet Healthcare Corporation common shareholders for basic loss per share$(226)103,398 $(2.19)
Effect of dilutive stock options, restricted stock units and deferred compensation units— — — 
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share$(226)103,398 $(2.19)
v3.22.0.1
FAIR VALUE MEASUREMENTS (Tables)
 12 Months Ended
Dec. 31, 2021
Fair Value Disclosures [Abstract]  
Schedule of Assets and Liabilities Measured at Fair Value on a Non-Recurring Basis 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 are 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.
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, 2020 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values:
 December 31, 2020Quoted Prices
in Active
Markets for
Identical Assets
(Level 1)		Significant Other
Observable Inputs
(Level 2)		Significant
Unobservable
Inputs
(Level 3)
Long-lived assets held for sale$140 $— $140 $— 
Long-lived assets held and used483 — 483 — 
$623 $— $623 $— 
v3.22.0.1
ACQUISITIONS (Tables)
 12 Months Ended
Dec. 31, 2021
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, 2021, 2020 and 2019 are as follows:
Years Ended December 31,
 202120202019
Current assets$59 $67 $16 
Property and equipment88 63 20 
Other intangible assets8 14 4 
Goodwill664 1,581 43 
Other long-term assets, including previously held equity method investments753 38 24 
Current liabilities(25)(45)(16)
Long-term liabilities(70)(43)(35)
Redeemable noncontrolling interests in equity of consolidated subsidiaries(139)(478)(18)
Noncontrolling interests(95)(20)(7)
Cash paid, net of cash acquired(1,220)(1,177)(25)
Gains on consolidations$23 $— $6 
Business Acquisition, Pro Forma Information
The following table provides certain pro forma information for Tenet as if the 2021 SCD Centers acquisition had occurred at the beginning of the year ended December 31, 2020:
 Year Ended December 31,
 20212020
Net operating revenues$19,627 $17,752 
Equity in earnings of unconsolidated affiliates$258 $192 
Net income available to Tenet Healthcare Corporation common shareholders$941 $416 
Diluted earnings per share available to Tenet Healthcare Corporation
common shareholders
$8.66 $3.92 
v3.22.0.1
SEGMENT INFORMATION (Tables)
 12 Months Ended
Dec. 31, 2021
Segment Reporting [Abstract]  
Reconciliation of Assets by Reportable Segment to Consolidated Assets
The following table includes 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:
December 31,
 202120202019
Assets:  
Hospital Operations$17,173 $18,048 $16,196 
Ambulatory Care9,473 8,048 6,195 
Conifer933 1,010 974 
Total 
$27,579 $27,106 $23,365 
Reconciliation of Other Significant Reconciling Items From Segments to Consolidated
 Years Ended December 31,
 202120202019
Capital expenditures:   
Hospital Operations$578 $467 $572 
Ambulatory Care66 51 75 
Conifer14 22 23 
Total 
$658 $540 $670 
Net operating revenues:   
Hospital Operations total prior to inter-segment eliminations$15,982 $14,790 $15,522 
Ambulatory Care2,718 2,072 2,158 
Conifer   
Tenet482 528 573 
Other clients785 778 799 
Total Conifer revenues1,267 1,306 1,372 
Inter-segment eliminations(482)(528)(573)
Total 
$19,485 $17,640 $18,479 
Equity in earnings of unconsolidated affiliates:   
Hospital Operations$25 $6 $15 
Ambulatory Care193 163 160 
Total 
$218 $169 $175 
Adjusted EBITDA:   
Hospital Operations$1,931 $1,911 $1,449 
Ambulatory Care1,197 868 895 
Conifer355 367 386 
Total 
$3,483 $3,146 $2,730 
Years Ended December 31,
202120202019
Depreciation and amortization:
Hospital Operations$722 $739 $733 
Ambulatory Care95 81 72 
Conifer38 37 45 
Total $855 $857 $850 
Adjusted EBITDA $3,483 $3,146 $2,730 
Income (loss) from divested and closed businesses(1)20 (2)
Depreciation and amortization(855)(857)(850)
Impairment and restructuring charges, and acquisition-related costs(85)(290)(185)
Litigation and investigation costs(116)(44)(141)
Interest expense(923)(1,003)(985)
Loss from early extinguishment of debt(74)(316)(227)
Other non-operating income (expense), net14 1 (5)
Net gains (losses) on sales, consolidation and deconsolidation of facilities445 14 (15)
Income from continuing operations, before income taxes$1,888 $671 $320 
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Description of Business (Details)
 12 Months Ended
Dec. 31, 2021
hospital
healthcare_facility
Business Acquisition [Line Items]  
Number of hospitals operated by subsidiaries | hospital 60
Number of outpatient centers 535
Number of outpatient centers recorded using equity method 167
Conifer Health Solutions, LLC  
Business Acquisition [Line Items]  
Ownership percentage of subsidiary 76.00%
United Surgical Partners International | Redeemable Noncontrolling Interests  
Business Acquisition [Line Items]  
Joint venture ownership (as a percentage) 95.00%
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Basis of Presentation (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Jan. 01, 2020
Jan. 01, 2019
Business Acquisition [Line Items]        
Increase (decrease) accumulated deficit $ (1,214) $ (2,128)    
Operating lease assets 1,002 1,062    
Operating lease liabilities, current 201 188    
Operating lease liabilities, long-term $ 924 $ 999    
Accounting Standards Update 2016-13 | Cumulative Effect, Period of Adoption, Adjustment        
Business Acquisition [Line Items]        
Increase (decrease) accumulated deficit     $ (14)  
Accounting Standards Update 2016-02        
Business Acquisition [Line Items]        
Operating lease assets       $ 822
Operating lease liabilities, current       147
Operating lease liabilities, long-term       715
Accounting Standards Update 2016-02 | Cumulative Effect, Period of Adoption, Adjustment        
Business Acquisition [Line Items]        
Increase (decrease) accumulated deficit       $ 1
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - COVID-19 Pandemic (Details) - USD ($)
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Business Acquisition [Line Items]      
Cash payments received including contributions from affiliates $ 215,000,000 $ 974,000,000  
Received cash payments 178,000,000 900,000,000  
Grant income 191,000,000 882,000,000 $ 0
Deferred revenue 5,000,000 18,000,000  
Contract liabilities 959,000,000 659,000,000  
Contract liabilities – long-term 15,000,000 918,000,000  
Accrued Compensation And Benefits      
Business Acquisition [Line Items]      
Deferred social security tax payments 128,000,000    
Equity Method Investment, Nonconsolidated Investee or Group of Investees      
Business Acquisition [Line Items]      
Received cash payments 37,000,000 74,000,000  
Grant income 14,000,000 17,000,000  
Hospital Operations      
Business Acquisition [Line Items]      
Received cash payments 142,000,000 824,000,000  
Grant income 142,000,000 823,000,000  
Contract liabilities advance payments 457,000,000    
Ambulatory Care      
Business Acquisition [Line Items]      
Received cash payments 36,000,000 76,000,000  
Grant income 49,000,000 59,000,000  
Contract liabilities advance payments 36,000,000    
Repayment of government advances 83,000,000    
Contract liabilities 4,000,000 93,000,000 0
Contract liabilities – long-term 0 83,000,000 $ 0
Ambulatory Care | Equity Method Investment, Nonconsolidated Investee or Group of Investees      
Business Acquisition [Line Items]      
Contract liabilities advance payments 40,000,000    
Repayment of government advances 64,000,000    
Contract liabilities   51,000,000  
Contract liabilities – long-term   62,000,000  
Hospital Operations And Ambulatory Care      
Business Acquisition [Line Items]      
Contract liabilities $ 880,000,000 603,000,000  
Contract liabilities – long-term   $ 902,000,000  
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Net Operating Revenues (Details)
 12 Months Ended
Dec. 31, 2021
Accounting Policies [Abstract]  
Cost report filing period after end of annual cost reporting period 5 months
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Cash and Cash Equivalents (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Cash and Cash Equivalents      
Cash and cash equivalents $ 2,364 $ 2,446  
Accrued property and equipment purchases for items received but not yet paid 95 93 $ 136
Captive Insurance Subsidiaries      
Cash and Cash Equivalents      
Cash and cash equivalents 188 166  
Accounts Payable      
Cash and Cash Equivalents      
Book overdrafts classified as accounts payable 226 154  
Accrued property and equipment purchases for items received but not yet paid $ 88 $ 85 $ 119
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Investments in Unconsolidated Affiliates (Details)
 12 Months Ended
Dec. 31, 2021
USD ($)
healthcare_facility
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Schedule of Equity Method Investments [Line Items]      
Number of outpatient centers recorded using equity method | healthcare_facility 167    
Grant income $ 191,000,000 $ 882,000,000 $ 0
Percentage of investee results reflected on date of acquisition 1    
Current assets $ 7,075,000,000 7,147,000,000  
Current liabilities (5,109,000,000) (4,847,000,000)  
Noncontrolling interests (1,026,000,000) (909,000,000)  
Net operating revenues 19,485,000,000 17,640,000,000 18,479,000,000
Net income 1,476,000,000 768,000,000 171,000,000
Equity in earnings of unconsolidated affiliates 218,000,000 169,000,000 175,000,000
Equity Method Investment, Nonconsolidated Investee or Group of Investees      
Schedule of Equity Method Investments [Line Items]      
Grant income 14,000,000 17,000,000  
Current assets 1,176,000,000 1,309,000,000 1,180,000,000
Noncurrent assets 1,390,000,000 1,262,000,000 1,042,000,000
Current liabilities (495,000,000) (516,000,000) (372,000,000)
Noncurrent liabilities (855,000,000) (866,000,000) (739,000,000)
Noncontrolling interests (659,000,000) (621,000,000) (579,000,000)
Net operating revenues 3,030,000,000 2,665,000,000 2,680,000,000
Net income 836,000,000 702,000,000 765,000,000
Net income attributable to the investees 499,000,000 437,000,000 499,000,000
Texas Health Ventures Group, LLC      
Schedule of Equity Method Investments [Line Items]      
Equity in earnings of unconsolidated affiliates $ 107,000,000 85,000,000 79,000,000
Ambulatory Care      
Schedule of Equity Method Investments [Line Items]      
Number of outpatient centers recorded not using equity method | healthcare_facility 257    
Number of outpatient centers recorded using equity method | healthcare_facility 166    
Number of outpatient centers | healthcare_facility 423    
Grant income $ 49,000,000 59,000,000  
Net operating revenues 2,718,000,000 2,072,000,000 2,158,000,000
Equity in earnings of unconsolidated affiliates $ 193,000,000 $ 163,000,000 $ 160,000,000
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Property and Equipment (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
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 $ 4 $ 5 $ 11
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Leases (Details)
 12 Months Ended
Dec. 31, 2021
renewal_option
Property and equipment  
Number of renewal options 1
Intangible assets, estimated useful life 15 years
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
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Goodwill and Other Intangible Assets (Details)
 12 Months Ended
Dec. 31, 2021
Goodwill and Other Intangible Assets  
Estimated useful life 15 years
Capitalized software costs | Minimum  
Goodwill and Other Intangible Assets  
Estimated useful life 3 years
Capitalized software costs | Maximum  
Goodwill and Other Intangible Assets  
Estimated useful life 15 years
v3.22.0.1
SIGNIFICANT ACCOUNTING POLICIES - Segment Reporting (Details)
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Accounting Policies [Abstract]      
Revenue generated by general hospitals 80.00% 81.00% 81.00%
v3.22.0.1
NONCONTROLLING INTERESTS (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance $ 2,054 $ 937 $ 437 $ 624
Net income attributable to noncontrolling interests 1,140 582 (21)  
Noncontrolling Interests        
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance 1,026 909 854 $ 806
Net income attributable to noncontrolling interests 226 183 194  
Noncontrolling Interests | Hospital Operations        
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance 128 116    
Net income attributable to noncontrolling interests 21 14 16  
Noncontrolling Interests | Ambulatory Care        
Noncontrolling Interest [Line Items]        
Noncontrolling interests balance 898 793    
Net income attributable to noncontrolling interests $ 205 $ 169 $ 178  
v3.22.0.1
ACCOUNTS RECEIVABLE - Components (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Accounts receivable and allowance for doubtful accounts    
Accounts receivable, net  $ 2,770 $ 2,690
Continuing Operations    
Accounts receivable and allowance for doubtful accounts    
Patient accounts receivable 2,600 2,499
Estimated future recoveries 137 156
Net cost reports and settlements receivable and valuation allowances 33 34
Accounts receivable, net  2,770 2,689
Discontinued operations    
Accounts receivable and allowance for doubtful accounts    
Accounts receivable, net  $ 0 $ 1
v3.22.0.1
ACCOUNTS RECEIVABLE - Location of Assets and Liabilities (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Assets:    
Other current assets $ 2,770 $ 2,690
Investments and other assets 213 206
Liabilities:    
Other current liabilities 1,300 1,207
California's Provider Fee Program | Other Current Assets    
Assets:    
Other current assets 370 378
California's Provider Fee Program | Other Assets    
Assets:    
Investments and other assets 213 206
California's Provider Fee Program | Other Current Liabilities    
Liabilities:    
Other current liabilities 123 110
California's Provider Fee Program | Other Long-term Liabilities    
Liabilities:    
Other long-term liabilities $ 60 $ 56
v3.22.0.1
ACCOUNTS RECEIVABLE - Allowance (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Accounts receivable and allowance for doubtful accounts      
Estimated costs of caring $ 747 $ 764 $ 820
Uninsured patients      
Accounts receivable and allowance for doubtful accounts      
Estimated costs of caring 650 617 664
Charity care patients      
Accounts receivable and allowance for doubtful accounts      
Estimated costs of caring $ 97 $ 147 $ 156
v3.22.0.1
CONTRACT BALANCES - Hospital Operations and Ambulatory Care Segments (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Disaggregation of Revenue [Line Items]    
Percentage of contract assets that meet the conditions for unconditional right to payment (percentage) 91.00% 91.00%
Contract Liability-Current Deferred Revenue    
Balance at beginning of period $ 659  
Balance at end of period 959 $ 659
Contract Liability-Long-term Deferred Revenue    
Balance at beginning of period 918  
Balance at end of period 15 918
Hospital Operations And Other    
Contract Assets    
Balance at beginning of period 208 170
Balance at end of period 181 208
Increase (decrease) (27) 38
Contract Liability-Current Deferred Revenue    
Balance at beginning of period 510 0
Balance at end of period 876 510
Contract Liability-Long-term Deferred Revenue    
Balance at beginning of period 819 0
Balance at end of period 0 819
Hospital Operations And Other | Short-term Contract with Customer    
Contract Liability-Current Deferred Revenue    
Increase (decrease) 366 510
Contract Liability-Long-term Deferred Revenue    
Increase (decrease) 366 510
Hospital Operations And Other | Long-term Contract with Customer    
Contract Liability-Current Deferred Revenue    
Increase (decrease) (819) 819
Contract Liability-Long-term Deferred Revenue    
Increase (decrease) (819) 819
Ambulatory Care    
Contract Liability-Current Deferred Revenue    
Balance at beginning of period 93 0
Balance at end of period 4 93
Contract Liability-Long-term Deferred Revenue    
Balance at beginning of period 83 0
Balance at end of period 0 83
Ambulatory Care | Equity Method Investment, Nonconsolidated Investee or Group of Investees    
Contract Liability-Current Deferred Revenue    
Balance at beginning of period 51  
Balance at end of period   51
Contract Liability-Long-term Deferred Revenue    
Balance at beginning of period 62  
Balance at end of period   62
Ambulatory Care | Short-term Contract with Customer    
Contract Liability-Current Deferred Revenue    
Increase (decrease) (89) 93
Contract Liability-Long-term Deferred Revenue    
Increase (decrease) (89) 93
Ambulatory Care | Long-term Contract with Customer    
Contract Liability-Current Deferred Revenue    
Increase (decrease) (83) 83
Contract Liability-Long-term Deferred Revenue    
Increase (decrease) $ (83) $ 83
v3.22.0.1
CONTRACT BALANCES - Conifer Segment (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Contract Liability-Current Deferred Revenue    
Balance at beginning of period $ 659  
Balance at end of period 959 $ 659
Contract Liability-Long-term Deferred Revenue    
Balance at beginning of period 918  
Balance at end of period 15 918
Conifer Segment    
Receivables    
Balance at beginning of period 56 26
Balance at end of period 28 56
Increase (decrease) (28) 30
Contract Asset-Unbilled Revenue    
Balance at beginning of period 20 11
Balance at end of period 18 20
Increase (decrease) (2) 9
Contract Liability-Current Deferred Revenue    
Balance at beginning of period 56 61
Balance at end of period 79 56
Contract Liability-Long-term Deferred Revenue    
Balance at beginning of period 16 18
Balance at end of period 15 16
Amount of revenue recognized by Conifer that was included in the opening current deferred revenue liability 56 61
Conifer Segment | Short-term Contract with Customer    
Contract Liability-Current Deferred Revenue    
Increase (decrease) 23 (5)
Contract Liability-Long-term Deferred Revenue    
Increase (decrease) 23 (5)
Conifer Segment | Long-term Contract with Customer    
Contract Liability-Current Deferred Revenue    
Increase (decrease) (1) (2)
Contract Liability-Long-term Deferred Revenue    
Increase (decrease) $ (1) $ (2)
v3.22.0.1
CONTRACT BALANCES - Contract Costs (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Revenue from Contract with Customer [Abstract]      
Amortized customer contract costs $ 4 $ 4 $ 5
Unamortized contract costs $ 23 $ 24  
v3.22.0.1
ASSETS AND LIABILITIES HELD FOR SALE - Narrative (Details)
 1 Months Ended 3 Months Ended 12 Months Ended
Aug. 31, 2021
hospital
Dec. 31, 2019
hospital
Mar. 31, 2019
hospital
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Current Assets and Liabilities Held for Sale            
Impairment charges       $ 8,000,000 $ 92,000,000 $ 42,000,000
Disposal Group, Held-for-sale, Not Discontinued Operations            
Current Assets and Liabilities Held for Sale            
Impairment charges       0 0 26,000,000
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    
Memphis Area | Disposal Group, Disposed of by Sale, Not Discontinued Operations            
Current Assets and Liabilities Held for Sale            
Number of hospitals | hospital   2        
Chicago-area | Disposal Group, Disposed of by Sale, Not Discontinued Operations            
Current Assets and Liabilities Held for Sale            
Gain (loss) on sale of properties         $ 5,000,000 $ 14,000,000
Number of hospitals | hospital     3      
v3.22.0.1
ASSETS AND LIABILITIES HELD FOR SALE - Significant Components (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]      
Accumulated other comprehensive loss $ 453 $ 70 $ 25
Chicago-area      
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]      
Accumulated other comprehensive loss (2) 3 (19)
Gain (loss) on sale of properties   5 14
Miami area      
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]      
Accumulated other comprehensive loss $ 455 $ 67 $ 44
v3.22.0.1
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2021
USD ($)
segment
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Impaired Long-Lived Assets Held and Used [Line Items]      
Number of continuing operating segments | segment 3    
Impairment and restructuring charges, and acquisition-related costs $ 85 $ 290 $ 185
Restructuring charges 57 184 137
Impairment charges 8 92 42
Acquisition costs 20 14 6
Acquisition-related transaction costs   14 6
Other impairment charges   16 16
Memphis Area      
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment charges     26
Buildings Subject To Impairment Charges      
Impaired Long-Lived Assets Held and Used [Line Items]      
Assets for which impairment charges have been recorded   483  
Series of Individual Business Acquisitions      
Impaired Long-Lived Assets Held and Used [Line Items]      
Acquisition-related transaction costs 20 14 6
Employee Severance      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges 14 65 57
Global Business Center in Republic of Philippines      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges 19 50 28
Other Restructuring      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges 24 32 46
USPI Management Equity Plan      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges   23  
Contract and Lease Termination Fees      
Impaired Long-Lived Assets Held and Used [Line Items]      
Restructuring charges   14 6
Ambulatory Care      
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment charges 5 12 6
Hospital Operations      
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment charges   79 31
Conifer Segment      
Impaired Long-Lived Assets Held and Used [Line Items]      
Impairment charges $ 3 $ 1 $ 5
v3.22.0.1
LEASES - Balance Sheet Components (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Leases [Abstract]    
Operating lease assets $ 1,002 $ 1,062
Finance lease assets 333 345
Total leased assets 1,335 1,407
Operating lease liabilities, current 201 188
Operating lease liabilities, long-term 924 999
Total operating lease liabilities 1,125 1,187
Finance lease liabilities, current 106 122
Finance lease liabilities, long-term 176 151
Total finance lease liabilities 282 273
Total lease liabilities $ 1,407 $ 1,460
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
v3.22.0.1
LEASES - Lease Costs (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Leases [Abstract]      
Operating lease expense $ 241 $ 247 $ 211
Finance lease expense:      
Amortization of leased assets 71 86 85
Interest on lease liabilities 9 11 15
Total finance lease expense 80 97 100
Variable and short term-lease expense 171 156 133
Total lease expense $ 492 $ 500 $ 444
Weighted-average remaining lease term (years), operating leases 7 years 6 months 7 years 10 months 24 days 7 years 9 months 18 days
Weighted-average remaining lease term (years), finance leases 5 years 8 months 12 days 5 years 8 months 12 days 5 years 4 months 24 days
Weighted-average discount rate, operating leases (percentage) 5.10% 5.50% 5.60%
Weighted-average discount rate, finance leases (percentage) 5.40% 5.60% 5.50%
v3.22.0.1
LEASES - Supplemental Cash Flow Information (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:      
Operating cash outflows from operating leases $ 237 $ 239 $ 197
Operating cash outflows from finance leases 12 15 18
Financing cash outflows from finance leases 140 154 151
Right-of-use assets obtained in exchange for lease obligations:      
Operating leases 176 304 249
Finance leases $ 136 $ 98 $ 141
v3.22.0.1
LEASES - Schedule of Lease Maturities (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Operating Leases    
2022 $ 236  
2023 211  
2024 185  
2025 156  
2026 124  
Later years 456  
Total lease payments 1,368  
Less: Imputed interest 243  
Total operating lease liabilities 1,125 $ 1,187
Less: Current obligations 201 188
Long-term lease obligations 924 999
Finance Leases    
2022 116  
2023 76  
2024 48  
2025 16  
2026 11  
Later years 83  
Total lease payments 350  
Less: Imputed interest 68  
Total finance lease liabilities 282 273
Less: Current obligations 106 122
Long-term lease obligations 176 151
Total    
2022 352  
2023 287  
2024 233  
2025 172  
2026 135  
Later years 539  
Total lease payments 1,718  
Less: Imputed interest 311  
Total lease liabilities 1,407 $ 1,460
Less: Current obligations 307  
Long-term lease obligations $ 1,100  
v3.22.0.1
LONG-TERM DEBT - Schedule of Debt (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 01, 2021
Mar. 31, 2021
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Apr. 30, 2020
Debt Instrument [Line Items]              
Finance leases, mortgage and other notes $ 443     $ 403      
Unamortized issue costs and note discounts (151)     (176)      
Total long-term debt 15,646     15,719      
Less current portion 135     145      
Long-term debt, net of current portion 15,511     15,574      
Senior Notes | 6.750% due 2023              
Debt Instrument [Line Items]              
Carrying amount $ 1,872     1,872      
Interest rate, stated percentage 6.75%            
Senior Notes | 7.000% due 2025              
Debt Instrument [Line Items]              
Carrying amount $ 0     478      
Interest rate, stated percentage 7.00%   7.00%        
Senior Notes | 6.125% due 2028              
Debt Instrument [Line Items]              
Carrying amount $ 2,500     2,500      
Interest rate, stated percentage 6.125%       6.125%    
Senior Notes | 6.875% due 2031              
Debt Instrument [Line Items]              
Carrying amount $ 362     362      
Interest rate, stated percentage 6.875%            
Senior Notes | 4.625% due 2024              
Debt Instrument [Line Items]              
Carrying amount $ 770     1,870      
Interest rate, stated percentage 4.625%            
Senior Notes | 4.625% due 2024              
Debt Instrument [Line Items]              
Carrying amount $ 600     600      
Interest rate, stated percentage 4.625%            
Senior Notes | 7.500% due 2025              
Debt Instrument [Line Items]              
Carrying amount $ 700     700      
Interest rate, stated percentage 7.50%           7.50%
Senior Notes | 4.875% due 2026              
Debt Instrument [Line Items]              
Carrying amount $ 2,100     2,100      
Interest rate, stated percentage 4.875%            
Senior Notes | 5.125% due 2027              
Debt Instrument [Line Items]              
Carrying amount $ 1,500     1,500      
Interest rate, stated percentage 5.125%            
Senior Notes | 4.625% due 2028              
Debt Instrument [Line Items]              
Carrying amount $ 600     600      
Interest rate, stated percentage 4.625%         4.625%  
Senior Notes | 4.250% due 2029              
Debt Instrument [Line Items]              
Carrying amount $ 1,400     0      
Interest rate, stated percentage 4.25%            
Senior Notes | 4.375% due 2030              
Debt Instrument [Line Items]              
Carrying amount $ 1,450     0      
Interest rate, stated percentage 4.375% 4.375%          
Senior Notes | 5.125% due 2025              
Debt Instrument [Line Items]              
Carrying amount $ 0     1,410      
Interest rate, stated percentage 5.125%            
Senior Notes | 6.250% due 2027              
Debt Instrument [Line Items]              
Carrying amount $ 1,500     $ 1,500      
Interest rate, stated percentage 6.25%            
v3.22.0.1
LONG-TERM DEBT - Credit Agreement and Letter of Credit Facility (Details)
 12 Months Ended
Dec. 31, 2021
USD ($)
day
Mar. 31, 2021
Jul. 31, 2020
Mar. 31, 2020
USD ($)
Feb. 29, 2020
USD ($)
Credit Agreement          
Debt Instrument [Line Items]          
Revolving credit facility, maximum borrowing capacity $ 1,900,000,000     $ 1,500,000,000  
Line of credit facility, subfacility maximum available capacity $ 200,000,000        
Incremental period 364 days        
Cash borrowings outstanding $ 0        
Standby letters of credit outstanding 1,000,000        
Amount available for borrowing under revolving credit facility $ 1,797,000,000        
Credit Agreement | Minimum          
Debt Instrument [Line Items]          
Unused commitment fee (percentage) 0.25%        
Credit Agreement | Maximum          
Debt Instrument [Line Items]          
Unused commitment fee (percentage) 0.375%        
Credit Agreement | Base rate | Minimum          
Debt Instrument [Line Items]          
Percentage margin on variable rate (percentage) 0.25%        
Credit Agreement | Base rate | Maximum          
Debt Instrument [Line Items]          
Percentage margin on variable rate (percentage) 0.75%        
Credit Agreement | Eurodollar | Minimum          
Debt Instrument [Line Items]          
Percentage margin on variable rate (percentage) 1.25%        
Credit Agreement | Eurodollar | Maximum          
Debt Instrument [Line Items]          
Percentage margin on variable rate (percentage) 1.75%        
Letter of Credit Facility          
Debt Instrument [Line Items]          
Revolving credit facility, maximum borrowing capacity       $ 200,000,000 $ 180,000,000
Standby letters of credit outstanding $ 139,000,000        
Maximum secured debt covenant ratio 4.25 6.00 4.25    
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%        
Letter of Credit Facility | Minimum          
Debt Instrument [Line Items]          
Unused commitment fee (percentage) 0.25%        
Letter of Credit Facility | Maximum          
Debt Instrument [Line Items]          
Unused commitment fee (percentage) 0.375%        
Number of business days after notice for reimbursement of drawings | day 3        
Letter of Credit Facility | Base rate          
Debt Instrument [Line Items]          
Percentage margin on variable rate (percentage) 0.50%        
v3.22.0.1
LONG-TERM DEBT - Senior Secured Notes and Senior Unsecured Notes (Details)
 1 Months Ended 3 Months Ended 12 Months Ended
Sep. 10, 2021
USD ($)
Jun. 02, 2021
USD ($)
Aug. 31, 2021
hospital
Sep. 30, 2020
USD ($)
Sep. 30, 2021
USD ($)
Jun. 30, 2021
USD ($)
Mar. 31, 2021
USD ($)
Sep. 30, 2020
USD ($)
Aug. 31, 2020
USD ($)
Mar. 31, 2020
USD ($)
Dec. 31, 2021
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Dec. 01, 2021
USD ($)
Jun. 30, 2020
USD ($)
Apr. 30, 2020
USD ($)
Debt Instrument [Line Items]                                
Loss from early extinguishment of debt                     $ (74,000,000) $ (316,000,000) $ (227,000,000)      
Miami-Area Hospitals | Disposal Group, Disposed of by Sale, Not Discontinued Operations                                
Debt Instrument [Line Items]                                
Number of hospitals for sale | hospital     5                          
Senior Notes                                
Debt Instrument [Line Items]                                
Redemption price percentage                     100.00%          
Repurchase obligation due to change of control percentage of principal                     101.00%          
Senior Notes | 4.375% due 2030                                
Debt Instrument [Line Items]                                
Aggregate principal amount                           $ 1,450,000,000    
Stated interest rate (percentage)                     4.375%     4.375%    
Senior Notes | 4.625% due 2024                                
Debt Instrument [Line Items]                                
Aggregate principal amount $ 1,870,000,000                              
Stated interest rate (percentage)                     4.625%          
Repurchased face amount 1,100,000,000                              
Repayments of Long-term Debt $ 1,113,000,000                              
Loss from early extinguishment of debt         $ (20,000,000)                      
Senior Notes | 4.250% due 2029                                
Debt Instrument [Line Items]                                
Aggregate principal amount   $ 1,400,000,000                            
Stated interest rate (percentage)                     4.25%          
Senior Notes | 5.125% due 2025                                
Debt Instrument [Line Items]                                
Stated interest rate (percentage)   5.125%                            
Repurchased face amount   $ 1,410,000,000                            
Loss from early extinguishment of debt           $ (31,000,000)                    
Repayments of Secured Debt   $ 1,428,000,000                            
Senior Notes | 7.000% due 2025                                
Debt Instrument [Line Items]                                
Stated interest rate (percentage)             7.00%       7.00%          
Repurchased face amount             $ 478,000,000                  
Repayments of Long-term Debt             495,000,000                  
Loss from early extinguishment of debt             $ (23,000,000)                  
Senior Notes | 6.125% due 2028                                
Debt Instrument [Line Items]                                
Aggregate principal amount       $ 2,500,000,000       $ 2,500,000,000                
Stated interest rate (percentage)       6.125%       6.125%     6.125%          
Senior Notes | 8.125% due 2022                                
Debt Instrument [Line Items]                                
Stated interest rate (percentage)       8.125%       8.125%                
Repurchased face amount       $ 2,556,000,000       $ 2,556,000,000 $ 244,000,000              
Loss from early extinguishment of debt               $ (305,000,000) (15,000,000)              
Repayments of debt       $ 2,843,000,000         $ 256,000,000              
Senior Notes | 4.625% due 2028                                
Debt Instrument [Line Items]                                
Aggregate principal amount                             $ 600,000,000  
Stated interest rate (percentage)                     4.625%       4.625%  
Senior Notes | 7.500% due 2025                                
Debt Instrument [Line Items]                                
Aggregate principal amount                               $ 700,000,000
Stated interest rate (percentage)                     7.50%         7.50%
Letter of Credit Facility | Credit Agreement                                
Debt Instrument [Line Items]                                
Repayments of debt                   $ 500,000,000            
v3.22.0.1
LONG-TERM DEBT - Covenants (Details)
 12 Months Ended
Dec. 31, 2021
USD ($)
quarter
Credit Agreement  
Covenants  
Threshold limit of revolving credit facility $ 150,000,000
Threshold limit of unused borrowing availability under the revolving credit facility (less than) $ 150,000,000
Threshold limit of unused borrowing availability under the revolving credit facility, number of consecutive days | quarter 3,000,000,000
Senior Notes | Minimum  
Covenants  
Asset value as a percentage of consolidated net tangible assets for properties to be defined as principal property (percentage) 5.00%
Senior Notes | Maximum  
Covenants  
Secured debt ratio 4.0
Asset value as a percentage of consolidated net tangible assets for properties to be defined as principal property (percentage) 15.00%
v3.22.0.1
LONG-TERM DEBT - Future Maturities (Details)
$ in Millions
Dec. 31, 2021
USD ($)
Long-term debt, including finance lease obligations  
Total $ 15,797
2022 135
2023 1,983
2024 1,446
2025 742
2026 2,120
Later Years $ 9,371
v3.22.0.1
GUARANTEES (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2021
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 $ 122
Income and Revenue Collection Guarantee | Other Current Liabilities  
GUARANTEES  
Liability for guarantees 104
Guaranteed Investees of Third Parties  
GUARANTEES  
Maximum potential amount of future payments under guarantees 94
Guaranteed Investees of Third Parties | Other Current Liabilities  
GUARANTEES  
Guarantee obligations for consolidated subsidiaries $ 12
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Share-based Compensation Plans (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Stock-based compensation costs, pretax $ 56 $ 44 $ 42
2019 Stock Incentive Plan      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Shares available for issuance under the plan (in shares) 5,300,000    
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    
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    
Restricted Stock Units | Minimum | Performance-based vesting      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage 0.00% 0.00%  
Restricted Stock Units | Maximum | Performance-based vesting      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Vesting percentage 200.00% 200.00%  
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Grant Dates Options and RSUs (Details) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Stock-based compensation costs, pretax $ 56 $ 44 $ 42
USPI Management Equity Plan      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 76,990 2,556,353  
Fair Value Per Share at Grant Date (in dollars per share) $ 34.13 $ 34.13  
Stock Options      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Granted (in dollars per share)     $ 28.28
Stock Options | Grant Date February 27, 2019      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 188,000    
Granted (in dollars per share) $ 28.26    
Fair Value Per Share at Grant Date (in dollars per share) $ 12.49    
Stock-based compensation costs, pretax $ 1    
Restricted Stock Units      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 900,018 1,767,730 1,481,021
Fair Value Per Share at Grant Date (in dollars per share) $ 58.61 $ 27.72 $ 27.87
Restricted Stock Units | Minimum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Fair Value Per Share at Grant Date (in dollars per share) 18.11    
Restricted Stock Units | Maximum      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Fair Value Per Share at Grant Date (in dollars per share) $ 74.99    
Restricted Stock Units | Grant Date February 27, 2019      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 790,000    
Fair Value Per Share at Grant Date (in dollars per share) $ 28.26    
Stock-based compensation costs, pretax $ 5    
Restricted Stock Units | Grant Date May 7, 2021      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 37,000    
Fair Value Per Share at Grant Date (in dollars per share) $ 47.99    
Stock-based compensation costs, pretax $ 2    
Restricted Stock Units | Grant Date February 24, 2021      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 585,000    
Fair Value Per Share at Grant Date (in dollars per share) $ 52.85    
Stock-based compensation costs, pretax $ 12    
Restricted Stock Units | Grant Date February 26, 2020      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 1,221,000    
Fair Value Per Share at Grant Date (in dollars per share) $ 27.80    
Stock-based compensation costs, pretax $ 15    
Restricted Stock Units | Grant Date January 31, 2019      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 318,000    
Fair Value Per Share at Grant Date (in dollars per share) $ 21.99    
Stock-based compensation costs, pretax $ 2    
Restricted Stock Units | Other Grants      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 661,000    
Fair Value Per Share at Grant Date (in dollars per share) $ 30.73    
Stock-based compensation costs, pretax $ 6    
Equity Option | USPI Management Equity Plan      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Awards (in shares) 1,883,000    
Fair Value Per Share at Grant Date (in dollars per share) $ 34.13    
Stock-based compensation costs, pretax $ 13    
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Stock Options (Details) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Options      
Granted (in shares) 0 0  
Stock Options      
Options      
Outstanding at the beginning of the period (in shares) 912,531 1,960,992 2,262,743
Granted (in shares)     230,713
Exercised (in shares) (391,533) (987,471) (306,427)
Forfeited/Expired (in shares)   (60,990) (226,037)
Outstanding at the end of the period (in shares) 520,998 912,531 1,960,992
Vested and expected to vest at the end of the period (in shares) 520,998    
Exercisable at the end of the period (in shares) 324,980    
Wtd. Avg. Exercise Price Per Share      
Outstanding at the beginning of the period (in dollars per share) $ 22.51 $ 20.24 $ 19.12
Granted (in dollars per share)     28.28
Exercised (in dollars per share) 20.66 17.96 18.05
Forfeited/Expired (in dollars per share)   23.28 20.21
Outstanding at the end of the period (in dollars per share) 23.90 $ 22.51 $ 20.24
Vested and expected to vest at the end of the period (in dollars per share) 23.90    
Exercisable at the end of the period (in dollars per share) $ 21.25    
Aggregate Intrinsic Value      
Outstanding at the end of the period $ 30    
Vested and expected to vest at the end of the period 30    
Exercisable at the end of the period $ 20    
Wtd. Avg Remaining Life      
Outstanding at the end of the period 6 years 2 months 12 days    
Vested and expected to vest at the end of the period 6 years 2 months 12 days    
Exercisable at the end of the period 5 years 8 months 12 days    
Aggregate intrinsic value of awards exercised $ 15 $ 15  
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Range of Exercise Prices (Details) - Stock Options
 12 Months Ended
Dec. 31, 2021
$ / shares
shares
Options Outstanding  
Number of options outstanding (in shares) | shares 520,998
Weighted average remaining contractual life 6 years 2 months 12 days
Weighted average exercise price (in dollars per share) $ 23.90
Options Exercisable  
Number of options exercisable (in shares) | shares 324,980
Weighted average exercise price (in dollars per share) $ 21.25
$18.99 to $20.609  
Options Outstanding  
Number of options outstanding (in shares) | shares 293,796
Weighted average remaining contractual life 5 years 7 months 6 days
Weighted average exercise price (in dollars per share) $ 19.75
Options Exercisable  
Number of options exercisable (in shares) | shares 293,796
Weighted average exercise price (in dollars per share) $ 19.75
$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  
Number of options outstanding (in shares) | shares 227,202
Weighted average remaining contractual life 6 years 10 months 24 days
Weighted average exercise price (in dollars per share) $ 29.26
Options Exercisable  
Number of options exercisable (in shares) | shares 31,184
Weighted average exercise price (in dollars per share) $ 35.43
$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
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Employee Options (Details) - $ / shares
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Stock Options        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 520,998 912,531 1,960,992 2,262,743
% of all outstanding options 100.00%      
% of Total 100.00%      
Share price (in dollars per share) $ 81.69      
Stock Options | Current employees        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 296,916      
% of Total 57.00%      
Stock Options | Former employees        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 224,082      
% of Total 43.00%      
In-the-Money Options        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 520,998      
% of all outstanding options 100.00%      
% of Total 100.00%      
In-the-Money Options | Current employees        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 296,916      
% of Total 57.00%      
In-the-Money Options | Former employees        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 224,082      
% of Total 43.00%      
Out-of-the-Money Options        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 0      
% of all outstanding options 0.00%      
% of Total 0.00%      
Out-of-the-Money Options | Current employees        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 0      
% of Total 0.00%      
Out-of-the-Money Options | Former employees        
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]        
Options outstanding (in shares) 0      
% of Total 0.00%      
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Restricted Stock Units (Details)
$ / shares in Units, $ in Millions
 1 Months Ended 12 Months Ended
May 31, 2020
shares
Dec. 31, 2021
USD ($)
quarter
$ / shares
shares
Dec. 31, 2020
quarter
$ / shares
shares
Dec. 31, 2019
$ / shares
shares
Restricted Stock Units        
Restricted Stock Units        
Unvested at the beginning of the period (in shares)   2,095,206 1,463,499 1,884,130
Granted (in shares)   900,018 1,767,730 1,481,021
Vested (in shares)   (765,814) (825,727) (1,562,191)
Forfeited (in shares)   (58,208) (310,296) (339,461)
Unvested at the end of the period (in shares)   2,171,202 2,095,206 1,463,499
Wtd. Avg. Grant Date Fair Value Per Unit        
Unvested at the beginning of the period (in dollars per share) | $ / shares   $ 25.87 $ 25.08 $ 32.25
Granted (in dollars per share) | $ / shares   58.61 27.72 27.87
Vested (in dollars per share) | $ / shares   30.51 25.66 36.45
Forfeited (in dollars per share) | $ / shares   37.60 32.09 24.74
Unvested at the end of the period (in dollars per share) | $ / shares   $ 40.51 $ 25.87 $ 25.08
Other Disclosures        
Awards (in shares)   900,018 1,767,730 1,481,021
Vesting period   3 years    
Unrecognized compensation costs | $   $ 47    
Period for recognition of unrecognized compensation costs   1 year 8 months 12 days    
Restricted Stock Units | Minimum        
Wtd. Avg. Grant Date Fair Value Per Unit        
Granted (in dollars per share) | $ / shares   $ 18.11    
Restricted Stock Units | Maximum        
Wtd. Avg. Grant Date Fair Value Per Unit        
Granted (in dollars per share) | $ / shares   $ 74.99    
Restricted Stock Units | Non Employee Directors        
Restricted Stock Units        
Granted (in shares) 103,434 39,738    
Other Disclosures        
Awards (in shares) 103,434 39,738    
Restricted Stock Units | Time-vesting        
Restricted Stock Units        
Granted (in shares)   561,788 1,084,883  
Other Disclosures        
Awards (in shares)   561,788 1,084,883  
Restricted Stock Units | Time-vesting | Director        
Restricted Stock Units        
Granted (in shares)   1,372    
Other Disclosures        
Awards (in shares)   1,372    
Restricted Stock Units | Time Based Vesting, Three Year Period from Grant Date        
Restricted Stock Units        
Granted (in shares)   263,180 607,198  
Other Disclosures        
Awards (in shares)   263,180 607,198  
Vesting period   3 years 3 years  
Restricted Stock Units | Eight Quarter Vesting Period        
Restricted Stock Units        
Granted (in shares)   189,215    
Other Disclosures        
Awards (in shares)   189,215    
Award vesting period, number of quarterly periods | quarter   8    
Restricted Stock Units | Time Based Vesting, Settled On Fourth Anniversary        
Restricted Stock Units        
Granted (in shares)   53,341    
Other Disclosures        
Awards (in shares)   53,341    
Restricted Stock Units | Time Based Vesting, Settled On Third Anniversary        
Restricted Stock Units        
Granted (in shares)   33,351 13,805  
Other Disclosures        
Awards (in shares)   33,351 13,805  
Restricted Stock Units | Time Based Vesting, One Year From Grant Date        
Restricted Stock Units        
Granted (in shares)   14,192    
Other Disclosures        
Awards (in shares)   14,192    
Restricted Stock Units | Time Based Vesting, Settled On Second Anniversary And Fourth Anniversary        
Restricted Stock Units        
Granted (in shares)   8,509    
Other Disclosures        
Awards (in shares)   8,509    
Restricted Stock Units | Eleven Quarter Vesting Period        
Restricted Stock Units        
Granted (in shares)     359,713  
Other Disclosures        
Awards (in shares)     359,713  
Award vesting period, number of quarterly periods | quarter     11  
Restricted Stock Units | Time Based Vesting, Four Year Period From Grant Date        
Restricted Stock Units        
Granted (in shares)     104,167  
Other Disclosures        
Awards (in shares)     104,167  
Vesting period     4 years  
Restricted Stock Units | Performance-based vesting        
Restricted Stock Units        
Granted (in shares)   298,492 579,413  
Unvested at the end of the period (in shares)   297,600    
Other Disclosures        
Awards (in shares)   298,492 579,413  
Restricted Stock Units | Performance-based vesting | Minimum        
Other Disclosures        
Vesting percentage   0.00% 0.00%  
Restricted Stock Units | Performance-based vesting | Maximum        
Other Disclosures        
Vesting percentage   200.00% 200.00%  
Restricted Stock Units | Performance Based Vesting Over A Three Year Period        
Restricted Stock Units        
Granted (in shares)   244,259 499,285  
Other Disclosures        
Awards (in shares)   244,259 499,285  
Restricted Stock Units | Performance Based Vesting On Fourth Anniversary | Senior Officer        
Restricted Stock Units        
Granted (in shares)   53,341 80,128  
Other Disclosures        
Awards (in shares)   53,341 80,128  
Restricted Stock Units | Performance Based Vesting And Settled Immediately        
Restricted Stock Units        
Granted (in shares)   892    
Other Disclosures        
Awards (in shares)   892    
Restricted Stock Units, 2021-2022 Board Service Year | Non Employee Directors        
Restricted Stock Units        
Granted (in shares)   36,681    
Other Disclosures        
Awards (in shares)   36,681    
Additional Prorated Restricted Stock Units | Time-vesting | Director        
Restricted Stock Units        
Granted (in shares)   1,685    
Other Disclosures        
Awards (in shares)   1,685    
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Valuation of Restricted Stock Units (Details) - Restricted Stock Units
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]    
Expected volatility   54.70%
Risk-free interest rate   1.20%
Minimum    
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]    
Expected volatility 65.20%  
Risk-free interest rate 0.10%  
Maximum    
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]    
Expected volatility 79.30%  
Risk-free interest rate 0.60%  
v3.22.0.1
EMPLOYEE BENEFIT PLANS - USPI Management Equity Plan (Details) - USD ($)
$ / shares in Units, $ in Millions
 1 Months Ended 12 Months Ended
Feb. 29, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2015
Wtd. Avg. Grant Date Fair Value Per Unit          
Payments to noncontrolling interest   $ 27.0 $ 39.0 $ 11.0  
Stock-based compensation costs, pretax   $ 56.0 $ 44.0 42.0  
2015 USPI Management Equity Plan | Nonqualified Plan          
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]          
Vesting period, days to be exercised before termination         90 days
2015 USPI Management Equity Plan | Equity Option | Nonqualified Plan          
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]          
Expected payment for vested securities and termination of plan $ 35.0        
2015 USPI Management Equity Plan | Minimum | Equity Option | Nonqualified Plan          
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]          
Percent of common stock allocated to plan         10.00%
Vesting period         3 years
2015 USPI Management Equity Plan | Maximum | Equity Option | Nonqualified Plan          
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]          
Vesting period         4 years
2020 USPI Management Equity Plan | Restricted Stock          
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]          
Contractual right to receive shares of common stock for a stock based award (in shares)   1      
USPI Management Equity Plan          
Number of Restricted Stock Units          
Unvested at the beginning of the period (in shares)   2,025,056      
Granted (in shares)   76,990 2,556,353    
Vested (in shares)   (388,588)      
Forfeited (in shares)   (218,576) (531,297)    
Unvested at the end of the period (in shares)   1,494,882 2,025,056    
Wtd. Avg. Grant Date Fair Value Per Unit          
Unvested at the beginning of the period (in dollars per share)   $ 34.13      
Granted (in dollars per share)   34.13 $ 34.13    
Vested (in dollars per share)   34.13      
Forfeited (in dollars per share)   34.13 34.13    
Unvested at the end of the period (in dollars per share)   $ 34.13 $ 34.13    
USPI Management Equity Plan | United Surgical Partners International          
Wtd. Avg. Grant Date Fair Value Per Unit          
Payments to noncontrolling interest   $ 9.0      
Noncontrolling interest purchased during period through issuance of equity (in shares)   0      
USPI Management Equity Plan | Restricted Stock          
Number of Restricted Stock Units          
Granted (in shares)   76,990 2,556,333    
USPI Management Equity Plan | Restricted Stock | Tranche One          
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]          
Vesting period     3 years    
Wtd. Avg. Grant Date Fair Value Per Unit          
Vesting percentage   20.00% 20.00%    
USPI Management Equity Plan | Restricted Stock | Tranche Two          
Wtd. Avg. Grant Date Fair Value Per Unit          
Vesting percentage   20.00% 20.00%    
USPI Management Equity Plan | Restricted Stock | Tranche Three          
Wtd. Avg. Grant Date Fair Value Per Unit          
Vesting percentage   60.00% 20.00%    
USPI Management Equity Plan | Restricted Stock | Tranche Four          
Wtd. Avg. Grant Date Fair Value Per Unit          
Vesting percentage     40.00%    
USPI Management Equity Plan | Equity Option          
Number of Restricted Stock Units          
Granted (in shares)   1,883,000      
Wtd. Avg. Grant Date Fair Value Per Unit          
Granted (in dollars per share)   $ 34.13      
Stock-based compensation costs, pretax   $ 13.0      
Vested and expected to vest at the end of the period (in shares)   1,494,882      
USPI Management Equity Plan | Equity Option | Nonqualified Plan          
Wtd. Avg. Grant Date Fair Value Per Unit          
Stock-based compensation costs, pretax   $ 13.0 $ 12.0 $ 11.0  
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Employee Stock Purchase Plan (Details) - Employee Stock Purchase Plan - USD ($)
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Number of shares authorized to be issued under the plan (in shares) 4,070,363    
Shares available for issuance under the plan (in shares) 2,700,000    
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) 89,865 254,767 215,422
Weighted average price (in dollars per share) $ 63.01 $ 19.97 $ 24.44
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%    
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Employee Retirement Plans (Details)
 12 Months Ended
Dec. 31, 2021
USD ($)
plan
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Employee Retirement Plans      
Number of defined contribution plans employees can participate in | plan 1    
Contribution expense $ 98,000,000 $ 119,000,000 $ 127,000,000
Projected benefit obligations      
Beginning obligations (1,429,000,000) (1,369,000,000)  
Interest cost (36,000,000) (47,000,000) (58,000,000)
Actuarial gain (loss) 42,000,000 (92,000,000)  
Benefits paid 110,000,000 79,000,000  
Ending obligations (1,313,000,000) (1,429,000,000) (1,369,000,000)
Fair value of plans assets      
Beginning plan assets 869,000,000 790,000,000  
Gain on plan assets 62,000,000 98,000,000  
Employer contribution 22,000,000 38,000,000  
Benefits paid (86,000,000) (57,000,000)  
Ending plan assets 867,000,000 869,000,000 790,000,000
Funded status of plans (446,000,000) (560,000,000)  
Accumulated benefit obligation 1,311,000,000 1,426,000,000  
Amounts recognized in the Consolidated Balance Sheets consist of:      
Other current liability (25,000,000) (63,000,000)  
Other long-term liability (421,000,000) (497,000,000)  
Accumulated other comprehensive loss 294,000,000 355,000,000  
Components of net periodic benefit costs      
Interest costs 36,000,000 47,000,000 58,000,000
Expected return on plan assets (53,000,000) (48,000,000) (46,000,000)
Amortization of net actuarial loss 11,000,000 9,000,000 10,000,000
Special termination benefit costs 0 0 1,000,000
Net periodic benefit cost (income) (6,000,000) 8,000,000 23,000,000
Net Periodic Benefit Costs Assumptions:      
Gain (loss) adjustments recorded in other comprehensive income (loss) 61,000,000 (32,000,000) (42,000,000)
Net actuarial losses 50,000,000 (41,000,000) (52,000,000)
Amortization of net actuarial loss (11,000,000) (9,000,000) (10,000,000)
Cumulative net actuarial losses 294,000,000 355,000,000 323,000,000
Unrecognized prior service costs $ 0 $ 0 $ 1,000,000
SERP      
Employee Retirement Plans      
Number of frozen plans | plan 3    
Accumulated Benefit Obligations Assumptions      
Discount rate 3.00% 2.75%  
Compensation increase rate 3.00% 3.00%  
Net Periodic Benefit Costs Assumptions:      
Discount rate 2.75% 3.50% 4.50%
Compensation increase rate 3.00% 3.00% 3.00%
Pension Plan      
Employee Retirement Plans      
Increase (decrease) in projected benefit obligations $ 5,000,000 $ (39,000,000)  
Fair value of plans assets      
Beginning plan assets 869,000,000    
Ending plan assets $ 867,000,000 $ 869,000,000  
Accumulated Benefit Obligations Assumptions      
Discount rate 2.89% 2.53%  
Net Periodic Benefit Costs Assumptions:      
Discount rate 2.53% 3.60% 4.62%
Long-term rate of return on assets 6.25% 6.25% 6.50%
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Asset Allocations (Details) - Pension Plan
Dec. 31, 2021
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 32.00%
Actual 28.00%
Debt securities  
Weighted-average asset allocations by asset category  
Target 58.00%
Actual 59.00%
Alternative investments  
Weighted-average asset allocations by asset category  
Target 11.00%
Actual 11.00%
v3.22.0.1
EMPLOYEE BENEFIT PLANS - Fair Value of Assets and Future Benefit Payments (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Employee Retirement Plans      
Fair value of DMC Pension Plan assets $ 867 $ 869 $ 790
SERP and DMC Pension Plan      
Total 828    
2022 83    
2023 84    
2024 85    
2025 85    
2026 85    
Five Years Thereafter 406    
Amounts recognized in the Consolidated Balance Sheets consist of:      
Benefit plan obligations (446) (560)  
Other current liability 25 63  
Defined benefit plan obligations 421 497  
Expected contribution to the plan for 2022 25    
Pension Plan      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 867 869  
Pension Plan | Cash and cash equivalents      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 11 44  
Pension Plan | Equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 242 484  
Pension Plan | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 67 76  
Pension Plan | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 448 240  
Pension Plan | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 57 8  
Pension Plan | Real estate securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 16    
Pension Plan | Hedge funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 26 17  
Pension Plan | Level 1      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 784 844  
Pension Plan | Level 1 | Cash and cash equivalents      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 11 44  
Pension Plan | Level 1 | Equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 242 484  
Pension Plan | Level 1 | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 67 76  
Pension Plan | Level 1 | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 448 240  
Pension Plan | Level 1 | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 1 | Real estate securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 16    
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 17  
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 | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2 | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2 | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 2 | Real estate securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0    
Pension Plan | Level 2 | Hedge funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 17  
Pension Plan | Level 3      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 83 8  
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 | U.S. government obligations      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 3 | Corporate debt securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0 0  
Pension Plan | Level 3 | Private equity securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 57 8  
Pension Plan | Level 3 | Real estate securities      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets 0    
Pension Plan | Level 3 | Hedge funds      
Employee Retirement Plans      
Fair value of DMC Pension Plan assets $ 26 $ 0  
v3.22.0.1
PROPERTY AND EQUIPMENT - Components (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Components of property and equipment    
Finance lease assets $ 479 $ 512
Total property, plant and equipment, gross 12,387 12,735
Accumulated depreciation and amortization (5,960) (6,043)
Net property and equipment 6,427 6,692
Land    
Components of property and equipment    
Property plant and equipment gross 635 612
Buildings and improvements    
Components of property and equipment    
Property plant and equipment gross 6,652 6,985
Construction in progress    
Components of property and equipment    
Property plant and equipment gross 166 33
Equipment    
Components of property and equipment    
Property plant and equipment gross $ 4,455 $ 4,593
v3.22.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS - Goodwill (Details) - USD ($)
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Changes in the carrying amount of goodwill    
Goodwill, Beginning Balance $ 8,808,000,000  
Goodwill at end of period 9,261,000,000 $ 8,808,000,000
Hospital Operations    
Changes in the carrying amount of goodwill    
Goodwill, gross, at beginning of period 5,375,000,000 5,338,000,000
Accumulated impairment losses (2,430,000,000) (2,430,000,000)
Goodwill, Beginning Balance 2,945,000,000 2,908,000,000
Goodwill transferred 41,000,000 0
Goodwill related to assets held for sale and disposed (178,000,000) 37,000,000
Goodwill, gross, at end of period 5,238,000,000 5,375,000,000
Accumulated impairment losses (2,430,000,000) (2,430,000,000)
Goodwill at end of period 2,808,000,000 2,945,000,000
Accumulated impairment losses 2,430,000,000 2,430,000,000
Ambulatory Care    
Changes in the carrying amount of goodwill    
Accumulated impairment losses 0  
Goodwill, Beginning Balance 5,258,000,000 3,739,000,000
Goodwill transferred (41,000,000) 0
Goodwill acquired during the year and purchase price allocation adjustments 664,000,000 1,581,000,000
Goodwill related to assets held for sale and disposed (33,000,000) (62,000,000)
Accumulated impairment losses 0 0
Goodwill at end of period 5,848,000,000 5,258,000,000
Accumulated impairment losses 0 0
Conifer    
Changes in the carrying amount of goodwill    
Accumulated impairment losses 0  
Goodwill, Beginning Balance 605,000,000 605,000,000
Goodwill acquired during the year and purchase price allocation adjustments 0 0
Goodwill related to assets held for sale and disposed 0 0
Accumulated impairment losses 0 0
Goodwill at end of period 605,000,000 605,000,000
Accumulated impairment losses $ 0 $ 0
v3.22.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS - Other Intangible Assets (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Information regarding other intangible assets    
Gross Carrying Amount $ 2,871 $ 2,884
Accumulated Amortization (1,374) (1,284)
Net Book Value 1,497 1,600
Capitalized software costs    
Information regarding other intangible assets    
Gross Carrying Amount 1,770 1,800
Accumulated Amortization (1,165) (1,084)
Net Book Value 605 716
Trade names    
Information regarding other intangible assets    
Gross Carrying Amount 102 102
Accumulated Amortization 0 0
Net Book Value 102 102
Contracts    
Information regarding other intangible assets    
Gross Carrying Amount 897 872
Accumulated Amortization (128) (111)
Net Book Value 769 761
Other    
Information regarding other intangible assets    
Gross Carrying Amount 102 110
Accumulated Amortization (81) (89)
Net Book Value $ 21 $ 21
v3.22.0.1
GOODWILL AND OTHER INTANGIBLE ASSETS - Amortization (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Estimated future amortization of intangibles with finite useful lives      
Total $ 786    
2022 147    
2023 119    
2024 108    
2025 94    
2026 73    
Later Years 245    
Amortization expense $ 188 $ 172 $ 188
v3.22.0.1
INVESTMENTS AND OTHER ASSETS - Components (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Investments, Debt and Equity Securities [Abstract]    
Marketable securities $ 9 $ 3
Equity investments in unconsolidated healthcare entities 1,806 1,024
Total investments 1,815 1,027
Cash surrender value of life insurance policies 47 42
Long-term deposits 57 67
California provider fee program receivables 213 206
Operating lease assets 1,002 1,062
Land held for expansion, other long-term receivables and other assets 120 130
Investments and other assets $ 3,254 $ 2,534
v3.22.0.1
ACCUMULATED OTHER COMPREHENSIVE LOSS (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss $ 1,028 $ 28
Tax benefit allocated to adjustments for defined benefit plans (14) 7
Adjustments for defined benefit plans    
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss (232) (281)
Foreign currency translation adjustments and other    
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss (1) 0
Accumulated Other Comprehensive Loss    
Accumulated Other Comprehensive Income (Loss) [Line Items]    
Accumulated other comprehensive loss $ (233) $ (281)
v3.22.0.1
NET OPERATING REVENUES - Net Operating Revenue By Source (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 19,485 $ 17,640 $ 18,479
Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  2,718 2,072 2,158
Conifer      
Disaggregation of Revenue [Line Items]      
Net operating revenues  1,267 1,306 1,372
Operating Segments | Hospital Operations      
Disaggregation of Revenue [Line Items]      
Net operating revenues  15,982 14,790 15,522
Operating Segments | Hospital Operations | Total | Acute Care Hospitals And Related Outpatient Facilities      
Disaggregation of Revenue [Line Items]      
Net operating revenues  14,759 13,618 14,368
Operating Segments | Hospital Operations | Medicare | Acute Care Hospitals And Related Outpatient Facilities      
Disaggregation of Revenue [Line Items]      
Net operating revenues  2,615 2,695 2,888
Operating Segments | Hospital Operations | Medicaid | Acute Care Hospitals And Related Outpatient Facilities      
Disaggregation of Revenue [Line Items]      
Net operating revenues  1,254 1,081 1,193
Operating Segments | Hospital Operations | Managed care | Acute Care Hospitals And Related Outpatient Facilities      
Disaggregation of Revenue [Line Items]      
Net operating revenues  9,985 9,022 9,516
Operating Segments | Hospital Operations | Uninsured | Acute Care Hospitals And Related Outpatient Facilities      
Disaggregation of Revenue [Line Items]      
Net operating revenues  199 162 92
Operating Segments | Hospital Operations | Indemnity and other | Acute Care Hospitals And Related Outpatient Facilities      
Disaggregation of Revenue [Line Items]      
Net operating revenues  706 658 679
Operating Segments | Hospital Operations | Other Revenues      
Disaggregation of Revenue [Line Items]      
Net operating revenues  1,223 1,172 1,154
Operating Segments | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  2,718 2,072 2,158
Operating Segments | Conifer      
Disaggregation of Revenue [Line Items]      
Net operating revenues  1,267 1,306 1,372
Inter-segment eliminations      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ (482) $ (528) $ (573)
v3.22.0.1
NET OPERATING REVENUES - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 19,485 $ 17,640 $ 18,479
Conifer      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 1,267 1,306 1,372
Revenue from other sources | Conifer      
Disaggregation of Revenue [Line Items]      
Percentage of net operating revenues related to Conifer generated by other services (percentage) 7.00%    
Revision of Prior Period, Adjustment      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 26 $ 6 $ 27
v3.22.0.1
NET OPERATING REVENUES - Net Operating Revenue Composition, Ambulatory Segment (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 19,485 $ 17,640 $ 18,479
Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  2,718 2,072 2,158
Net patient service revenues | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  2,604 1,960 2,040
Management fees | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  86 86 95
Revenue from other sources | Ambulatory Care      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 28 $ 26 $ 23
v3.22.0.1
NET OPERATING REVENUES - Net Operating Revenue Composition, Conifer Segment (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 19,485 $ 17,640 $ 18,479
Conifer      
Disaggregation of Revenue [Line Items]      
Net operating revenues  1,267 1,306 1,372
Tenet | Conifer | Health Care - Client Contracts - Revenue Cycle Services      
Disaggregation of Revenue [Line Items]      
Net operating revenues  467 514 556
Tenet | Conifer | Health Care - Client Contracts - Other Services      
Disaggregation of Revenue [Line Items]      
Net operating revenues  15 14 17
Other Customers | Conifer | Health Care - Client Contracts - Revenue Cycle Services      
Disaggregation of Revenue [Line Items]      
Net operating revenues  705 700 713
Other Customers | Conifer | Health Care - Client Contracts - Other Services      
Disaggregation of Revenue [Line Items]      
Net operating revenues  $ 80 $ 78 $ 86
v3.22.0.1
NET OPERATING REVENUES - Performance Obligation (Details)
$ in Millions
Dec. 31, 2021
USD ($)
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, expected timing of satisfaction, period 1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, expected timing of satisfaction, period 1 year
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, 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, 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, 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, expected timing of satisfaction, period
Conifer  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount $ 6,181
Conifer | Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount 606
Conifer | Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01  
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]  
Revenue, remaining performance obligation, amount 606
Conifer | 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 552
Conifer | 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 552
Conifer | 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 552
Conifer | 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 $ 3,313
v3.22.0.1
PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE (Details) - Scenario, Forecast
$ in Millions
 12 Months Ended
Mar. 31, 2022
USD ($)
Insurance coverage  
Insurance coverage, aggregate limit $ 850
Floods  
Insurance coverage  
Property insurance coverage 100
Earthquakes  
Insurance coverage  
Property insurance coverage $ 200
Insurance deductible (percentage) 5.00%
Windstorms  
Insurance coverage  
Property insurance coverage $ 200
Fires and Other Perils  
Insurance coverage  
Property insurance coverage $ 850
Floods, Earthquakes and Windstorms  
Insurance coverage  
Insurance deductible (percentage) 5.00%
California Earthquake  
Insurance coverage  
Insurance deductible $ 25
Floods And Windstorms  
Insurance coverage  
Insurance deductible $ 25
New Madrid Fault Earthquakes  
Insurance coverage  
Insurance deductible (percentage) 2.00%
Insurance deductible $ 25
Fires and Certain Other Covered Losses  
Insurance coverage  
Insurance deductible $ 1
v3.22.0.1
PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE - Professional and General Liability Reserves (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Insurance coverage      
Malpractice expense, portion related to adverse developments in prior years $ 131 $ 120 $ 155
Other Operating Expense, Net      
Insurance coverage      
Malpractice expense 355 320 $ 356
Professional and General Liability Reserves      
Insurance coverage      
Self insurance reserve $ 1,045 $ 978  
v3.22.0.1
CLAIMS AND LAWSUITS - Narrative (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2021
USD ($)
Other Matters  
Loss Contingencies  
Reserve of estimated obligation $ 23
Various Employment Matters  
Loss Contingencies  
Reserve of estimated obligation 39
Settlement payments $ 11
v3.22.0.1
CLAIMS AND LAWSUITS - Reconciliations (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Loss Contingency Accrual [Roll Forward]      
Litigation and investigation costs $ 116 $ 44 $ 141
Claims, Lawsuits, and Regulatory Proceedings      
Loss Contingency Accrual [Roll Forward]      
Litigation reserve, Balances at Beginning of Period 26 86 8
Litigation and investigation costs 116 44 141
Cash Payments (59) (108) (55)
Other (5) 4 (8)
Litigation reserve, Balances at End of Period $ 78 $ 26 $ 86
v3.22.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Narrative (Details) - United Surgical Partners International - Baylor University Medical Center
Feb. 18, 2022
Dec. 31, 2021
Feb. 28, 2021
Apr. 01, 2017
Put Option        
Interests acquired and other disclosures        
Ownership percentage   5.00%    
Put Option | Maximum        
Interests acquired and other disclosures        
Purchasable equity In joint venture, percentage of total shares (percentage)   0.333   0.3333
Call Option | Maximum        
Interests acquired and other disclosures        
Purchasable equity In joint venture, percentage of total shares (percentage)     0.333  
Call Option | Maximum | Subsequent Event        
Interests acquired and other disclosures        
Purchasable equity In joint venture, percentage of total shares (percentage) 0.333      
v3.22.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Changes in Redeemable Noncontrolling Interests (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Increase (Decrease) in Temporary Equity [Roll Forward]      
Balances at beginning of period  $ 1,952    
Net income 336 $ 186 $ 192
Distributions paid to noncontrolling interests (206) (152) (162)
Balances at end of period  2,203 1,952  
Redeemable Noncontrolling Interests      
Increase (Decrease) in Temporary Equity [Roll Forward]      
Balances at beginning of period  1,952 1,506  
Net income 336 186  
Distributions paid to noncontrolling interests (217) (135)  
Accretion of redeemable noncontrolling interests 11 4  
Purchases and sales of businesses and noncontrolling interests, net 121 391  
Balances at end of period  $ 2,203 $ 1,952 $ 1,506
v3.22.0.1
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Segment Details (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Increase (Decrease) in Temporary Equity [Roll Forward]      
Redeemable noncontrolling interests $ 2,203 $ 1,952  
Net income available to redeemable noncontrolling interests 336 186 $ 192
Hospital Operations      
Increase (Decrease) in Temporary Equity [Roll Forward]      
Redeemable noncontrolling interests 297 267  
Net income available to redeemable noncontrolling interests 24 (33) (37)
Ambulatory Care      
Increase (Decrease) in Temporary Equity [Roll Forward]      
Redeemable noncontrolling interests 1,425 1,273  
Net income available to redeemable noncontrolling interests 243 153 159
Conifer      
Increase (Decrease) in Temporary Equity [Roll Forward]      
Redeemable noncontrolling interests 481 412  
Net income available to redeemable noncontrolling interests $ 69 $ 66 $ 70
v3.22.0.1
INCOME TAXES - Provision and Deferred Taxes (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Current tax expense (benefit):      
Federal $ 50 $ 0 $ (6)
State 111 30 26
Total 161 30 20
Deferred tax expense (benefit):      
Federal 267 (131) 140
State (17) 4 0
Total 250 (127) 140
Income tax expense (benefit) $ 411 $ (97) $ 160
v3.22.0.1
INCOME TAXES - Federal Tax Reconciliation (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Income Tax Disclosure [Abstract]      
Decrease in valuation allowance due to changes based on expiration or worthlessness of unutilized state net operating loss carryovers $ 2 $ 1 $ 2
Income tax benefit, reduction in valuation allowance of expired or worthless operating loss carryforwards 2    
Foreign pretax loss 5 13 6
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% 396 141 67
State income taxes, net of federal income tax benefit 77 33 21
Expired state net operating losses, net of federal income tax benefit 0 1 2
Tax benefit attributable to noncontrolling interests (114) (75) (79)
Nondeductible goodwill 35 0 4
Nondeductible executive compensation 8 6 6
Nondeductible litigation costs 1 0 7
Expired charitable contribution carryforward 0 1 8
Stock-based compensation tax deficiencies (benefits) (5) (2) 4
Changes in valuation allowance 2 (226) 133
Change in tax contingency reserves, including interest 0 0 (14)
Prior-year provision to return adjustments and other changes in deferred taxes 8 14 (3)
Other items 3 10 4
Income tax expense (benefit) $ 411 $ (97) $ 160
v3.22.0.1
INCOME TAXES - Narrative (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2020
USD ($)
Income Tax Disclosure [Abstract]  
Income tax expense (benefit) $ (88)
Increase (decrease) in deferred tax valuation allowance due to a change in tax accounting method $ (126)
v3.22.0.1
INCOME TAXES - Components of Deferred Tax Assets and Liabilities (Details) - USD ($)
$ in Millions
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Assets      
Reserves related to discontinued operations and restructuring charges $ 2 $ 8  
Receivables (doubtful accounts and adjustments) 215 173  
Medicare advance payments 209 0  
Accruals for retained insurance risks 234 223  
Other long-term liabilities 23 55  
Benefit plans 242 265  
Other accrued liabilities 56 74  
Interest expense limitation 10 8  
Net operating loss carryforwards 99 566  
Stock-based compensation 12 11  
Right-of-use lease assets and obligations 208 224  
Other items 48 86  
Deferred tax assets, gross 1,358 1,693  
Valuation allowance (57) (55) $ (281)
Deferred tax assets, net 1,301 1,638  
Liabilities      
Depreciation and fixed-asset differences 532 621  
Intangible assets 396 385  
Investments and other assets 92 73  
Right-of-use lease assets and obligations 208 224  
Other items 44 39  
Deferred tax liabilities, gross, total 1,272 1,342  
Deferred tax liabilities, total 1,272 1,342  
Reconciliation of the deferred tax assets and liabilities      
Deferred income tax assets 65 325  
Deferred tax liabilities (36) (29)  
Net deferred tax asset $ 29 $ 296  
v3.22.0.1
INCOME TAXES - Valuation Allowances and Unrecognized Tax Benefits (Details) - USD ($)
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
INCOME TAXES      
Increase (decrease) in valuation allowance against deferred tax assets $ 2,000,000 $ (226,000,000) $ 133,000,000
Increase (decrease) in valuation allowance due to limitations on deductions of interest expense 2,000,000 (211,000,000) 130,000,000
Decrease in valuation allowance due to changes based on expiration or worthlessness of unutilized state net operating loss carryovers 2,000,000 1,000,000 2,000,000
Increase (decrease) in valuation allowance due to changes in expected realizability of deferred tax assets 2,000,000 (14,000,000) 5,000,000
Valuation allowance 57,000,000 55,000,000 281,000,000
Changes in unrecognized tax benefits      
Beginning balance 31,000,000 31,000,000  
Ending balance 34,000,000 31,000,000 31,000,000
Unrecognized tax benefits which, if recognized, would impact effective tax rate 32,000,000 29,000,000 29,000,000
Current income tax benefit due to decrease in liabilities for uncertain tax positions     11,000,000
Total accrued interest and penalties on unrecognized tax benefits 0    
Continuing Operations      
Changes in unrecognized tax benefits      
Beginning balance 31,000,000 31,000,000 45,000,000
Reductions due to a lapse of statute of limitations   0 (14,000,000)
Increases due to tax positions taken in prior periods 3,000,000    
Ending balance $ 34,000,000 $ 31,000,000 $ 31,000,000
v3.22.0.1
INCOME TAXES - NOL and Tax Credit Carryforwards (Details) - USD ($)
Dec. 31, 2021
Dec. 31, 2020
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 90,000,000  
Deferred tax benefit, net of valuation allowance and federal tax impact, associated with NOL carryforwards 99,000,000 $ 566,000,000
General Business Tax Credit Carryforward    
Operating loss carryforwards    
Tax credits carryforwards 9,000,000  
Federal    
Operating loss carryforwards    
Net operating loss carryforwards 194,000,000  
Operating loss carryforwards, subject to expiration 13,000,000  
Operating loss carryforwards, not subject to expiration 181,000,000  
State    
Operating loss carryforwards    
Operating loss carryforwards, subject to expiration 3,333,000,000  
Deferred tax benefit, net of valuation allowance and federal tax impact, associated with NOL carryforwards $ 49,000,000  
v3.22.0.1
EARNINGS (LOSS) PER COMMON SHARE (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Net Income Available (Loss Attributable) to Common Shareholders (Numerator)      
Net income (loss) available/attributable to Tenet Healthcare Corporation common shareholders for basic earnings per share $ 915 $ 399 $ (226)
Net income (loss) available/attributable to Tenet Healthcare Corporation common shareholders for diluted earnings per share $ 915 $ 399 $ (226)
Weighted Average Shares (Denominator)      
Net income (loss) available/attributable to Tenet Healthcare Corporation common shareholders for basic earnings per share (in shares) 106,833 105,010 103,398
Effect of dilutive stock options, restricted stock units and deferred compensation units (in shares) 1,738 1,253 0
Net income (loss) available/attributable to Tenet Healthcare Corporation common shareholders for diluted earnings per share (in shares) 108,571 106,263 103,398
Per-Share Amount      
Net income (loss) available/attributable to Tenet Healthcare Corporation common shareholders for basic earnings per share (in dollars per share) $ 8.56 $ 3.80 $ (2.19)
Effect of dilutive stock options, restricted stock units, and deferred compensation units (in dollars per share) (0.13) (0.05) 0
Net income (loss) available/attributable to Tenet Healthcare Corporation common shareholders for diluted earnings per share (in dollars per share) $ 8.43 $ 3.75 $ (2.19)
v3.22.0.1
EARNINGS (LOSS) PER COMMON SHARE - Antidilutive securities (Details)
shares in Thousands
 12 Months Ended
Dec. 31, 2019
shares
Employee stock options, restricted stock units and deferred compensation units  
Antidilutive securities  
Anti-dilutive securities excluded from computation of earnings per share (in shares) 1,457
v3.22.0.1
FAIR VALUE MEASUREMENTS (Details) - Fair Value, Nonrecurring
$ in Millions
Dec. 31, 2020
USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]  
Long-lived assets held for sale $ 140
Long-lived assets held and used 483
Fair value assets 623
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 assets 0
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 140
Long-lived assets held and used 483
Fair value assets 623
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 assets $ 0
v3.22.0.1
FAIR VALUE MEASUREMENTS - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Impairment charges $ 76  
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 104.50% 103.30%
v3.22.0.1
ACQUISITIONS - Narrative (Details)
 1 Months Ended 12 Months Ended
Dec. 31, 2021
USD ($)
surgery_center
Dec. 31, 2020
USD ($)
surgical_center
Dec. 31, 2021
USD ($)
hospital
business
surgery_center
Dec. 31, 2020
USD ($)
business
Dec. 31, 2019
USD ($)
business
Business Acquisition [Line Items]          
Goodwill $ 9,261,000,000 $ 8,808,000,000 $ 9,261,000,000 $ 8,808,000,000  
Acquisition-related transaction costs       14,000,000 $ 6,000,000
Ambulatory Care          
Business Acquisition [Line Items]          
Goodwill 5,848,000,000 5,258,000,000 5,848,000,000 5,258,000,000 3,739,000,000
Series of Individual Business Acquisitions          
Business Acquisition [Line Items]          
Goodwill $ 664,000,000 $ 1,581,000,000 664,000,000 1,581,000,000 43,000,000
Acquisition-related transaction costs     20,000,000 14,000,000 6,000,000
Gains on consolidations     $ 23,000,000 0 6,000,000
Series of Individual Business Acquisitions | Ambulatory Care          
Business Acquisition [Line Items]          
Number of surgical centers acquired | surgery_center     2    
Cash paid to acquire businesses     $ 21,000,000    
Consideration conveyed in the acquisition     $ 74,000,000 $ 80,000,000 $ 25,000,000
Number of business acquisitions | business     11 10 10
Number of hospitals | hospital     3    
Number of off-campus emergency departments and various physician practices | business         3
United Surgical Partners International | Ambulatory Care          
Business Acquisition [Line Items]          
Number of ambulatory surgery centers | hospital     399    
United Surgical Partners International | 2021 SCD Centers | Ambulatory Care          
Business Acquisition [Line Items]          
Number of surgical centers acquired | surgery_center 86        
Number of ambulatory surgery centers | surgery_center 15        
Number of ambulatory surgery centers noncontrolling interests | surgery_center 57        
Number of ambulatory surgery centers development stage | surgery_center 14        
Cash paid to acquire businesses $ 1,125,000,000        
United Surgical Partners International | 2020 SCD Centers | Ambulatory Care          
Business Acquisition [Line Items]          
Number of surgical centers acquired | surgical_center   45      
Cash paid to acquire businesses   $ 1,097,000,000.000      
Consideration conveyed in the acquisition   1,115,000,000      
Debt incurred in acquisition of surgical centers   $ 18,000,000      
v3.22.0.1
ACQUISITIONS - Purchase Price Allocation (Details) - USD ($)
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Final purchase price allocations      
Goodwill $ 9,261,000,000 $ 8,808,000,000  
Cash paid, net of cash acquired (1,220,000,000) (1,177,000,000) $ (25,000,000)
Series of Individual Business Acquisitions      
Final purchase price allocations      
Current assets 59,000,000 67,000,000 16,000,000
Property and equipment 88,000,000 63,000,000 20,000,000
Other intangible assets 8,000,000 14,000,000 4,000,000
Goodwill 664,000,000 1,581,000,000 43,000,000
Other long-term assets, including previously held equity method investments 753,000,000 38,000,000 24,000,000
Current liabilities (25,000,000) (45,000,000) (16,000,000)
Long-term liabilities (70,000,000) (43,000,000) (35,000,000)
Redeemable noncontrolling interests in equity of consolidated subsidiaries (139,000,000) (478,000,000) (18,000,000)
Noncontrolling interests (95,000,000) (20,000,000) (7,000,000)
Cash paid, net of cash acquired (1,220,000,000) (1,177,000,000) (25,000,000)
Gains on consolidations $ 23,000,000 $ 0 $ 6,000,000
v3.22.0.1
ACQUISITIONS - Pro Forma Information (Details) - 2021 SCD Centers - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Business Acquisition [Line Items]    
Net operating revenues $ 19,627 $ 17,752
Equity in earnings of unconsolidated affiliates 258 192
Net income available to Tenet Healthcare Corporation common shareholders $ 941 $ 416
Diluted earnings (loss) per share available (attributable) to Tenet Healthcare Corporation common shareholders (in dollars per share) $ 8.66 $ 3.92
v3.22.0.1
SEGMENT INFORMATION - Narrative (Details)
 3 Months Ended 12 Months Ended
Apr. 01, 2021
imaging_center
hospital
Mar. 31, 2021
Dec. 31, 2021
surgery_center
hospital
state
Concentration Risk [Line Items]      
Number of hospitals owned by subsidiaries     60
Conifer Health Solutions, LLC      
Concentration Risk [Line Items]      
Ownership percentage of subsidiary     76.00%
Hospital Operations      
Concentration Risk [Line Items]      
Number of hospitals owned by subsidiaries     60
Number of states in which entity operates | state     9
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 | United Surgical Partners International      
Concentration Risk [Line Items]      
Ownership percentage of subsidiary     95.00%
Ambulatory Care | United Surgical Partners International      
Concentration Risk [Line Items]      
Number of states in which entity operates | state     34
Number of ambulatory surgery centers     399
Number of ambulatory surgery centers consolidated | surgery_center     249
Number of surgical centers operated by subsidiaries     24
Number of surgical hospitals consolidated     8
Number of urgent care centers 40    
Conifer      
Concentration Risk [Line Items]      
Number of hospitals to which segment of the entity provides revenue cycle services     650
v3.22.0.1
SEGMENT INFORMATION - Reconciling Items (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Segment Reporting Information [Line Items]      
Assets $ 27,579 $ 27,106 $ 23,365
Capital expenditures 658 540 670
Net operating revenues  19,485 17,640 18,479
Equity in earnings of unconsolidated affiliates 218 169 175
Adjusted EBITDA  3,483 3,146 2,730
Depreciation and amortization 855 857 850
Adjusted Segment EBITDA [Abstract]      
Adjusted EBITDA  3,483 3,146 2,730
Income (loss) from divested and closed businesses (1) 20 (2)
Depreciation and amortization (855) (857) (850)
Impairment and restructuring charges, and acquisition-related costs (85) (290) (185)
Litigation and investigation costs (116) (44) (141)
Interest expense (923) (1,003) (985)
Gain (loss) from early extinguishment of debt (74) (316) (227)
Other non-operating income (expense), net 14 1 (5)
Net gains (losses) on sales, consolidation and deconsolidation of facilities 445 14 (15)
Income from continuing operations, before income taxes 1,888 671 320
Inter-segment eliminations      
Segment Reporting Information [Line Items]      
Net operating revenues  (482) (528) (573)
Hospital Operations      
Segment Reporting Information [Line Items]      
Assets 17,173 18,048 16,196
Capital expenditures 578 467 572
Equity in earnings of unconsolidated affiliates 25 6 15
Adjusted EBITDA  1,931 1,911 1,449
Depreciation and amortization 722 739 733
Adjusted Segment EBITDA [Abstract]      
Adjusted EBITDA  1,931 1,911 1,449
Depreciation and amortization (722) (739) (733)
Hospital Operations | Operating segments      
Segment Reporting Information [Line Items]      
Net operating revenues  15,982 14,790 15,522
Ambulatory Care      
Segment Reporting Information [Line Items]      
Assets 9,473 8,048 6,195
Capital expenditures 66 51 75
Net operating revenues  2,718 2,072 2,158
Equity in earnings of unconsolidated affiliates 193 163 160
Adjusted EBITDA  1,197 868 895
Depreciation and amortization 95 81 72
Adjusted Segment EBITDA [Abstract]      
Adjusted EBITDA  1,197 868 895
Depreciation and amortization (95) (81) (72)
Ambulatory Care | Operating segments      
Segment Reporting Information [Line Items]      
Net operating revenues  2,718 2,072 2,158
Conifer      
Segment Reporting Information [Line Items]      
Assets 933 1,010 974
Capital expenditures 14 22 23
Net operating revenues  1,267 1,306 1,372
Adjusted EBITDA  355 367 386
Depreciation and amortization 38 37 45
Adjusted Segment EBITDA [Abstract]      
Adjusted EBITDA  355 367 386
Depreciation and amortization (38) (37) (45)
Conifer | Operating segments      
Segment Reporting Information [Line Items]      
Net operating revenues  1,267 1,306 1,372
Conifer | Operating segments | Tenet      
Segment Reporting Information [Line Items]      
Net operating revenues  482 528 573
Conifer | Operating segments | Other clients      
Segment Reporting Information [Line Items]      
Net operating revenues  $ 785 $ 778 $ 799
v3.22.0.1
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS (Details) - Valuation allowance for deferred tax assets - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Movement in valuation and qualifying accounts      
Balance at Beginning of Period $ 55 $ 281 $ 148
Costs and Expenses 2 (226) 133
Deductions 0 0 0
Other Items 0 0 0
Balance at End of Period $ 57 $ 55 $ 281
v3.22.0.1
SUBSEQUENT EVENT (Details) - 7.500% due 2025 - Senior Notes - USD ($)
Feb. 09, 2022
Apr. 30, 2020
Subsequent events    
Aggregate principal amount   $ 700,000,000
Subsequent Event    
Subsequent events    
Aggregate principal amount $ 700,000,000