HCA HEALTHCARE, INC., 10-Q filed on 11/1/2022
Quarterly Report
v3.22.2.2
Cover Page - shares
9 Months Ended
Sep. 30, 2022
Oct. 24, 2022
Cover [Abstract]    
Document Type 10-Q  
Amendment Flag false  
Document Period End Date Sep. 30, 2022  
Document Fiscal Year Focus 2022  
Document Fiscal Period Focus Q3  
Trading Symbol HCA  
Entity Registrant Name HCA Healthcare, Inc.  
Entity Central Index Key 0000860730  
Current Fiscal Year End Date --12-31  
Entity Current Reporting Status Yes  
Entity Filer Category Large Accelerated Filer  
Entity Shell Company false  
Entity Small Business false  
Entity Emerging Growth Company false  
Entity Common Stock, Shares Outstanding   282,716,700
Entity Interactive Data Current Yes  
Entity File Number 1-11239  
Entity Incorporation, State or Country Code DE  
Entity Tax Identification Number 27-3865930  
Entity Address, Address Line One One Park Plaza  
Entity Address, City or Town Nashville  
Entity Address, State or Province TN  
Entity Address, Postal Zip Code 37203  
City Area Code 615  
Local Phone Number 344-9551  
Document Quarterly Report true  
Document Transition Report false  
Title of 12(b) Security Voting common stock, $.01 par value  
Security Exchange Name NYSE  
v3.22.2.2
Condensed Consolidated Income Statements (Unaudited) - USD ($)
shares in Thousands, $ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Income Statement [Abstract]        
Revenues $ 14,971 $ 15,276 $ 44,736 $ 43,688
Salaries and benefits 6,899 7,094 20,630 19,780
Supplies 2,320 2,463 6,942 7,067
Other operating expenses 2,860 2,530 8,305 7,424
Equity in earnings of affiliates (10) (35) (29) (78)
Depreciation and amortization 749 716 2,219 2,125
Interest expense 446 398 1,288 1,168
Losses (gains) on sales of facilities 3 (1,047) 25 (1,057)
Losses on retirement of debt 0 0 78 12
Total expenses including equity in earnings of affiliates 13,267 12,119 39,458 36,441
Income before income taxes 1,704 3,157 5,278 7,247
Provision for income taxes 360 685 1,090 1,531
Net income 1,344 2,472 4,188 5,716
Net income attributable to noncontrolling interests 210 203 626 574
Net income attributable to HCA Healthcare, Inc. $ 1,134 $ 2,269 $ 3,562 $ 5,142
Per share data:        
Basic earnings $ 3.97 $ 7.13 $ 12.13 $ 15.67
Diluted earnings $ 3.91 $ 7.00 $ 11.97 $ 15.43
Shares used in earnings per share calculations (in millions):        
Basic 285,958 318,072 293,583 328,048
Diluted 289,852 324,029 297,702 333,248
v3.22.2.2
Condensed Consolidated Comprehensive Income Statements (Unaudited) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Statement of Comprehensive Income [Abstract]        
Net income $ 1,344 $ 2,472 $ 4,188 $ 5,716
Other comprehensive (loss) income before taxes:        
Foreign currency translation (76) (31) (181) (20)
Unrealized losses on available-for-sale securities (16) (3) (58) (12)
Losses included in other operating expenses 0 0 1 0
Total Unrealized losses on available-for-sale securities (16) (3) (57) (12)
Defined benefit plans 0 0 0 0
Pension costs included in salaries and benefits 2 7 7 21
Total defined benefit plans 2 7 7 21
Change in fair value of derivative financial instruments 1 (1) 6 (1)
Interest costs included in interest expense 0 10 4 28
Total change in fair value of derivative financial instruments 1 9 10 27
Other comprehensive (loss) income before taxes (89) (18) (221) 16
Income taxes (benefits) related to other comprehensive income items (12) (1) (33) 6
Other comprehensive (loss) income (77) (17) (188) 10
Comprehensive income 1,267 2,455 4,000 5,726
Comprehensive income attributable to noncontrolling interests 210 203 626 574
Comprehensive income attributable to HCA Healthcare, Inc. $ 1,057 $ 2,252 $ 3,374 $ 5,152
v3.22.2.2
Condensed Consolidated Balance Sheets - USD ($)
$ in Millions
Sep. 30, 2022
Dec. 31, 2021
Current assets:    
Cash and cash equivalents $ 999 $ 1,451
Accounts receivable 8,552 8,095
Inventories 2,009 1,986
Other 1,921 2,010
Total current assets 13,481 13,542
Property and equipment, at cost 53,730 51,350
Accumulated depreciation (28,752) (27,287)
Property and equipment, net 24,978 24,063
Investments of insurance subsidiaries 372 438
Investments in and advances to affiliates 444 448
Goodwill and other intangible assets 9,651 9,540
Right-of-use operating lease assets 2,097 2,113
Other 461 598
Total assets 51,484 50,742
Current liabilities:    
Accounts payable 4,161 4,111
Accrued salaries 1,625 1,912
Other accrued expenses 3,780 3,322
Long-term debt due within one year 218 237
Total current liabilities 9,784 9,582
Long-term debt, less debt issuance costs and discounts of $309 and $248 37,492 34,342
Professional liability risks 1,510 1,514
Right-of-use operating lease obligations 1,762 1,755
Income taxes and other liabilities 1,714 2,060
Stockholders' equity (deficit):    
Common stock $0.01 par; authorized 1,800,000,000 shares; outstanding 283,903,500 shares -2022 and 305,476,800 shares - 2021 3 3
Accumulated other comprehensive loss (592) (404)
Retained deficit (2,781) (532)
Stockholders' deficit attributable to HCA Healthcare, Inc. (3,370) (933)
Noncontrolling interests 2,592 2,422
Total stockholders' equity (778) 1,489
Total liabilities and stockholders' equity $ 51,484 $ 50,742
v3.22.2.2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($)
$ in Millions
Sep. 30, 2022
Dec. 31, 2021
Statement of Financial Position [Abstract]    
Debt issuance costs $ 309 $ 248
Common stock, par value $ 0.01 $ 0.01
Common stock, shares authorized 1,800,000,000 1,800,000,000
Common stock, shares outstanding 283,903,500 305,476,800
v3.22.2.2
Condensed Consolidated Statements of Stockholders' Equity (Deficit) (Unaudited) - USD ($)
$ in Millions
Total
Common Stock [Member]
Capital in Excess of Par Value [Member]
Accumulated Other Comprehensive Loss [Member]
Retained Earnings (Deficit) [Member]
Equity Attributable to Noncontrolling Interests [Member]
Balances at Dec. 31, 2020 $ 2,892 $ 3 $ 294 $ (502) $ 777 $ 2,320
Balance, shares at Dec. 31, 2020   339,426,000        
Comprehensive income 1,591     11 1,423 157
Repurchase of common stock (1,527)   (225)   (1,302)  
Repurchase of common stock, shares   (8,477,000)        
Share-based benefit plans (75)   (75)      
Share-based benefit plans, shares   2,765,000        
Cash dividends declared (163)       (163)  
Distributions (234)         (234)
Other (2)   6     (8)
Balance at Mar. 31, 2021 2,482 $ 3   (491) 735 2,235
Balance, shares at Mar. 31, 2021   333,714,000        
Balances at Dec. 31, 2020 2,892 $ 3 294 (502) 777 2,320
Balance, shares at Dec. 31, 2020   339,426,000        
Comprehensive income 5,726          
Balance at Sep. 30, 2021 1,825 $ 3   (492) (206) 2,520
Balance, shares at Sep. 30, 2021   313,502,000        
Balances at Mar. 31, 2021 2,482 $ 3   (491) 735 2,235
Balance, shares at Mar. 31, 2021   333,714,000        
Comprehensive income 1,680     16 1,450 214
Repurchase of common stock (2,287)   (142)   (2,145)  
Repurchase of common stock, shares   (11,261,000)        
Share-based benefit plans 140   140      
Share-based benefit plans, shares   372,000        
Cash dividends declared (161)       (161)  
Distributions (123)         (123)
Other 59   2     57
Balance at Jun. 30, 2021 1,790 $ 3   (475) (121) 2,383
Balance, shares at Jun. 30, 2021   322,825,000        
Comprehensive income 2,455     (17) 2,269 203
Repurchase of common stock (2,329)   (130)   (2,199)  
Repurchase of common stock, shares   (9,605,000)        
Share-based benefit plans 127   127      
Share-based benefit plans, shares   282,000        
Cash dividends declared (155)       (155)  
Distributions (144)         (144)
Other 81   3     78
Balance at Sep. 30, 2021 1,825 $ 3   (492) (206) 2,520
Balance, shares at Sep. 30, 2021   313,502,000        
Comprehensive income 2,093     88 1,814 191
Repurchase of common stock (2,072)   (81)   (1,991)  
Repurchase of common stock, shares   (8,469,000)        
Share-based benefit plans 88   88      
Share-based benefit plans, shares   444,000        
Cash dividends declared (149)       (149)  
Distributions (248)         (248)
Other (48)   (7)     (41)
Balance at Dec. 31, 2021 1,489 $ 3   (404) (532) 2,422
Balance, shares at Dec. 31, 2021   305,477,000        
Comprehensive income 1,422     (43) 1,273 192
Repurchase of common stock (2,101)       (2,101)  
Repurchase of common stock, shares   (8,375,000)        
Share-based benefit plans (57)       (57)  
Share-based benefit plans, shares   1,879,000        
Cash dividends declared (171)       (171)  
Distributions (171)         (171)
Other 3       (1) 4
Balance at Mar. 31, 2022 414 $ 3   (447) (1,589) 2,447
Balance, shares at Mar. 31, 2022   298,981,000        
Balances at Dec. 31, 2021 1,489 $ 3   (404) (532) 2,422
Balance, shares at Dec. 31, 2021   305,477,000        
Comprehensive income $ 4,000          
Repurchase of common stock, shares (23,966,000)          
Balance at Sep. 30, 2022 $ (778) $ 3   (592) (2,781) 2,592
Balance, shares at Sep. 30, 2022   283,904,000        
Balances at Mar. 31, 2022 414 $ 3   (447) (1,589) 2,447
Balance, shares at Mar. 31, 2022   298,981,000        
Comprehensive income 1,311     (68) 1,155 224
Repurchase of common stock (2,682)   (111)   (2,571)  
Repurchase of common stock, shares   (12,230,000)        
Share-based benefit plans 118   118      
Share-based benefit plans, shares   253,000        
Cash dividends declared (163)       (163)  
Distributions (162)         (162)
Other 22   (7)     29
Balance at Jun. 30, 2022 (1,142) $ 3   (515) (3,168) 2,538
Balance, shares at Jun. 30, 2022   287,004,000.000        
Comprehensive income 1,267     (77) 1,134 210
Repurchase of common stock (698)   (113)   (585)  
Repurchase of common stock, shares   (3,361,000)        
Share-based benefit plans 116   116      
Share-based benefit plans, shares   261,000        
Cash dividends declared (162)       (162)  
Distributions (217)         (217)
Other 58   $ (3)     61
Balance at Sep. 30, 2022 $ (778) $ 3   $ (592) $ (2,781) $ 2,592
Balance, shares at Sep. 30, 2022   283,904,000        
v3.22.2.2
Condensed Consolidated Statements of Stockholders' Equity (Deficit) (Parenthetical) (Unaudited) - $ / shares
3 Months Ended
Sep. 30, 2022
Jun. 30, 2022
Mar. 31, 2022
Dec. 31, 2021
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Statement of Stockholders' Equity [Abstract]              
Cash dividends declared, per share $ 0.56 $ 0.56 $ 0.56 $ 0.48 $ 0.48 $ 0.48 $ 0.48
v3.22.2.2
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)
$ in Millions
9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Cash flows from operating activities:    
Net income $ 4,188 $ 5,716
Increase (decrease) in cash from operating assets and liabilities:    
Accounts receivable (487) (1,312)
Inventories and other assets 53 (333)
Accounts payable and accrued expenses (644) 731
Depreciation and amortization 2,219 2,125
Income taxes 159 185
Losses (gains) on sales of facilities 25 (1,057)
Losses on retirement of debt 78 12
Amortization of debt issuance costs and discounts 22 21
Share-based compensation 258 341
Other 124 87
Net cash provided by operating activities 5,995 6,516
Cash flows from investing activities:    
Purchase of property and equipment (3,072) (2,385)
Acquisition of hospitals and health care entities (176) (488)
Sales of hospitals and health care entities 652 1,980
Change in investments 10 (38)
Other (10) 2
Net cash used in investing activities (2,596) (929)
Cash flows from financing activities:    
Issuance of long-term debt 5,976 4,337
Net change in revolving credit facilities (230) 500
Repayment of long-term debt (2,774) (3,787)
Distributions to noncontrolling interests (550) (501)
Payment of debt issuance costs (53) (38)
Payment of dividends (497) (476)
Repurchase of common stock (5,481) (6,143)
Other (209) (241)
Net cash used in financing activities (3,818) (6,349)
Effect of exchange rate changes on cash and cash equivalents (33) (4)
Change in cash and cash equivalents (452) (766)
Cash and cash equivalents at beginning of period 1,451 1,793
Cash and cash equivalents at end of period 999 1,027
Interest payments 1,329 1,127
Income tax payments, net $ 931 $ 1,346
v3.22.2.2
Basis of Presentation and Significant Accounting Policies
9 Months Ended
Sep. 30, 2022
Accounting Policies [Abstract]  
Basis of Presentation and Significant Accounting Policies

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity

HCA Healthcare, Inc. is a holding company whose affiliates own and operate hospitals and related health care entities. The term “affiliates” includes direct and indirect subsidiaries of HCA Healthcare, Inc. and partnerships and joint ventures in which such subsidiaries are partners. At September 30, 2022, these affiliates owned and operated 182 hospitals, 125 freestanding surgery centers, 21 freestanding endoscopy centers and provided extensive outpatient and ancillary services. HCA Healthcare, Inc.’s facilities are located in 20 states and England. The terms “Company,” “HCA,” “we,” “our” or “us,” as used herein and unless otherwise stated or indicated by context, refer to HCA Healthcare, Inc. and its affiliates. The terms “facilities” or “hospitals” refer to entities owned and operated by affiliates of HCA and the term “employees” refers to employees of affiliates of HCA.

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $91 million and $87 million for the quarters ended September 30, 2022 and 2021, respectively, and $281 million and $301 million for the nine months ended September 30, 2022 and 2021, respectively. Operating results for the quarter and nine months ended September 30, 2022 are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2021.

COVID-19

We believe the extent of COVID-19’s impact on our operating results and financial condition has been and could continue to be driven by many factors, most of which are beyond our control and ability to forecast. Because of these uncertainties, we cannot estimate how long or to what extent COVID-19 will impact our operations.

Revenues

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued)

Revenues (continued)

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2022 and 2021 are summarized in the following table (dollars in millions):

 

 

 

Quarter

 

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

2,569

 

 

 

17.2

%

 

$

2,645

 

 

 

17.3

%

Managed Medicare

 

 

2,229

 

 

 

14.9

 

 

 

2,124

 

 

 

13.9

 

Medicaid

 

 

797

 

 

 

5.3

 

 

 

692

 

 

 

4.5

 

Managed Medicaid

 

 

939

 

 

 

6.3

 

 

 

813

 

 

 

5.3

 

Managed care and insurers

 

 

7,184

 

 

 

47.9

 

 

 

7,998

 

 

 

52.4

 

International (managed care and insurers)

 

 

311

 

 

 

2.1

 

 

 

324

 

 

 

2.1

 

Other

 

 

942

 

 

 

6.3

 

 

 

680

 

 

 

4.5

 

Revenues

 

$

14,971

 

 

 

100.0

%

 

$

15,276

 

 

 

100.0

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nine Months

 

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

7,790

 

 

 

17.4

%

 

$

7,816

 

 

 

17.9

%

Managed Medicare

 

 

6,813

 

 

 

15.2

 

 

 

6,281

 

 

 

14.4

 

Medicaid

 

 

1,987

 

 

 

4.4

 

 

 

1,722

 

 

 

3.9

 

Managed Medicaid

 

 

3,003

 

 

 

6.7

 

 

 

2,369

 

 

 

5.4

 

Managed care and insurers

 

 

21,480

 

 

 

48.1

 

 

 

22,300

 

 

 

51.0

 

International (managed care and insurers)

 

 

992

 

 

 

2.2

 

 

 

995

 

 

 

2.3

 

Other

 

 

2,671

 

 

 

6.0

 

 

 

2,205

 

 

 

5.1

 

Revenues

 

$

44,736

 

 

 

100.0

%

 

$

43,688

 

 

 

100.0

%

 

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued)

Revenues (continued)

 

To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2022 and 2021 follows (dollars in millions):

 

 

Quarter

 

 

Nine Months

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

12,828

 

 

$

12,803

 

 

$

38,096

 

 

$

36,396

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

11.2

%

 

 

11.8

%

 

 

11.2

%

 

 

11.4

%

Total uncompensated care

 

$

8,050

 

 

$

7,782

 

 

$

23,512

 

 

$

22,299

 

Multiply by the cost-to-charges ratio

 

 

11.2

%

 

 

11.8

%

 

 

11.2

%

 

 

11.4

%

Estimated cost of total uncompensated care

 

$

901

 

 

$

916

 

 

$

2,633

 

 

$

2,542

 

 

The total uncompensated care amounts include charity care of $3.206 billion and $3.509 billion, respectively, and the related estimated costs of charity care were $359 million and $413 million, respectively, for the quarters ended September 30, 2022 and 2021. The total uncompensated care amounts include charity care of $10.281 billion and $10.135 billion, respectively, and the related estimated costs of charity care were $1.151 billion and $1.155 billion, respectively, for the nine months ended September 30, 2022 and 2021.

Reclassifications

Certain prior year amounts have been reclassified to conform to the current year presentation.

v3.22.2.2
Acquisitions and Dispositions
9 Months Ended
Sep. 30, 2022
Business Combinations [Abstract]  
Acquisitions and Dispositions

NOTE 2 — ACQUISITIONS AND DISPOSITIONS

During the nine months ended September 30, 2022, we paid $176 million to acquire nonhospital health care entities. During the nine months ended September 30, 2021, we paid $67 million to acquire two hospital facilities, one in southern Georgia and one in Tennessee, and $91 million to acquire other nonhospital health care entities. We also paid $330 million and assumed certain liabilities to acquire an 80% interest in a venture providing post-acute care services (home health and hospice). Purchase price amounts have been allocated to the related assets acquired and liabilities assumed based upon their respective fair values.

During the nine months ended September 30, 2022, we received proceeds of $38 million and recognized pretax losses of $25 million related to sales of real estate and other health care entity investments. We also received net proceeds of $614 million on September 30, 2022 related to the sale of a controlling interest in a subsidiary of our group purchasing organization, which was effective October 1, 2022. During the nine months ended September 30, 2021, we received proceeds of $860 million and recognized a pretax gain of $655 million related to the sale of four hospital facilities in Georgia (two facilities in northern Georgia and two facilities in southern Georgia). We received proceeds of $647 million on September 30, 2021 related to the sale of a hospital facility in northern Georgia, which sale was effective October 1, 2021. We also received proceeds of $473 million and recognized a pretax gain of $402 million related to sales of other health care entity investments and minor real estate assets.

v3.22.2.2
Income Taxes
9 Months Ended
Sep. 30, 2022
Income Tax Disclosure [Abstract]  
Income Taxes

NOTE 3 — INCOME TAXES

Our provisions for income taxes for the quarters ended September 30, 2022 and 2021 were $360 million and $685 million, respectively, and the effective tax rates were 24.1% and 23.2%, respectively. Our provisions for income taxes for the nine months ended September 30, 2022 and 2021 were $1.090 billion and $1.531 billion, respectively, and the effective tax rates were 23.4% and 22.9%, respectively. Our provisions for income taxes included tax benefits related to settlements of employee equity awards of $70 million and $96 million for the nine months ended September 30, 2022 and 2021, respectively.

Our liability for unrecognized tax benefits was $670 million, including accrued interest of $116 million, as of September 30, 2022 ($642 million and $99 million, respectively, as of December 31, 2021). Unrecognized tax benefits of $246 million ($217 million as of December 31, 2021) would affect the effective rate, if recognized.

At September 30, 2022, the Internal Revenue Service was conducting examinations of the Company’s 2016, 2017 and 2018 federal income tax returns and the 2019 return for one affiliated partnership. We are also subject to examination by state and foreign taxing authorities. Depending on the resolution of any federal, state and foreign tax disputes, the completion of examinations by federal, state or foreign taxing authorities, or the expiration of statutes of limitation for specific taxing jurisdictions, we believe it is reasonably possible that our liability for unrecognized tax benefits may significantly increase or decrease within the next 12 months. However, we are currently unable to estimate the range of any possible change.
v3.22.2.2
Earnings Per Share
9 Months Ended
Sep. 30, 2022
Earnings Per Share [Abstract]  
Earnings Per Share

NOTE 4 — EARNINGS PER SHARE

We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards, computed using the treasury stock method.

 

The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2022 and 2021 (dollars and shares in millions, except per share amounts):

 

 

 

Quarter

 

 

Nine Months

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Net income attributable to HCA Healthcare, Inc.

 

$

1,134

 

 

$

2,269

 

 

$

3,562

 

 

$

5,142

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

285.958

 

 

 

318.072

 

 

 

293.583

 

 

 

328.048

 

Effect of dilutive incremental shares

 

 

3.894

 

 

 

5.957

 

 

 

4.119

 

 

 

5.200

 

Shares used for diluted earnings per share

 

 

289.852

 

 

 

324.029

 

 

 

297.702

 

 

 

333.248

 

Earnings per share:

 

 

 

 

 

 

 

 

 

 

 

 

Basic earnings

 

$

3.97

 

 

$

7.13

 

 

$

12.13

 

 

$

15.67

 

Diluted earnings

 

$

3.91

 

 

$

7.00

 

 

$

11.97

 

 

$

15.43

 

v3.22.2.2
Investments of Insurance Subsidiaries
9 Months Ended
Sep. 30, 2022
Investments, Debt and Equity Securities [Abstract]  
Investments of Insurance Subsidiaries

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES

A summary of our insurance subsidiaries’ investments at September 30, 2022 and December 31, 2021 follows (dollars in millions):

 

 

 

September 30, 2022

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

410

 

 

$

 

 

$

(41

)

 

$

369

 

Money market funds and other

 

 

124

 

 

 

 

 

 

 

 

 

124

 

 

 

$

534

 

 

$

 

 

$

(41

)

 

 

493

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(121

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

372

 

 

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

 

 

 

December 31, 2021

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

400

 

 

$

18

 

 

$

(2

)

 

$

416

 

Money market funds and other

 

 

125

 

 

 

 

 

 

 

 

 

125

 

 

 

$

525

 

 

$

18

 

 

$

(2

)

 

 

541

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(103

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

438

 

 

 

At September 30, 2022 and December 31, 2021, the investments in debt securities of our insurance subsidiaries were classified as “available-for-sale.” Changes in unrealized gains and losses that are not credit-related are recorded as adjustments to other comprehensive income (loss).

 

Scheduled maturities of investments in debt securities at September 30, 2022 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

26

 

 

$

26

 

Due after one year through five years

 

 

127

 

 

 

121

 

Due after five years through ten years

 

 

181

 

 

 

155

 

Due after ten years

 

 

76

 

 

 

67

 

 

 

$

410

 

 

$

369

 

 

The average expected maturity of the investments in debt securities at September 30, 2022 was 5.8 years, compared to the average scheduled maturity of 8.7 years. Expected and scheduled maturities may differ because the issuers of certain securities have the right to call, prepay or otherwise redeem such obligations prior to their scheduled maturity date.

v3.22.2.2
Assets and Liabilities Measured at Fair Value
9 Months Ended
Sep. 30, 2022
Fair Value Disclosures [Abstract]  
Assets and Liabilities Measured at Fair Value

NOTE 6 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”), emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.

 

NOTE 6 — ASSETS AND LIABILITIES MEASURED AT FAIR VALUE (continued)

Investment Securities

The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency.

Derivative Financial Instrument

We have entered into an interest rate swap agreement to manage our exposure to fluctuations in interest rates. The valuation of this instrument is determined using widely accepted valuation techniques, including a discounted expected cash flow analysis.

The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2022 and December 31, 2021, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

 

September 30, 2022

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Assets:

 

 

 

 

 

 

 

 

 

 

 

 

Investments of insurance subsidiaries:

 

 

 

 

 

 

 

 

 

 

 

 

Debt securities

 

$

369

 

 

$

 

 

$

369

 

 

$

 

Money market funds and other

 

 

124

 

 

 

124

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

493

 

 

 

124

 

 

 

369

 

 

 

 

Less amounts classified as current assets

 

 

(121

)

 

 

(115

)

 

 

(6

)

 

 

 

 

 

$

372

 

 

$

9

 

 

$

363

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interest rate swap (Other current assets)

 

$

2

 

 

$

 

 

$

2

 

 

$

 

 

 

 

 

December 31, 2021

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Assets:

 

 

 

 

 

 

 

 

 

 

 

 

Investments of insurance subsidiaries:

 

 

 

 

 

 

 

 

 

 

 

 

Debt securities

 

$

416

 

 

$

 

 

$

416

 

 

$

 

Money market funds and other

 

 

125

 

 

 

125

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

541

 

 

 

125

 

 

 

416

 

 

 

 

Less amounts classified as current assets

 

 

(103

)

 

 

(103

)

 

 

 

 

 

 

 

 

$

438

 

 

$

22

 

 

$

416

 

 

$

 

Liabilities:

 

 

 

 

 

 

 

 

 

 

 

 

Interest rate swap (Other accrued expenses)

 

$

8

 

 

$

 

 

$

8

 

 

$

 

 

 

The estimated fair value of our debt was $34.293 billion and $38.541 billion at September 30, 2022 and December 31, 2021, respectively, compared to carrying amounts, excluding debt issuance costs and discounts, aggregating $38.019 billion and $34.827 billion, respectively. The estimates of fair value are generally based upon the quoted market prices or quoted market prices for similar issues of debt with the same maturities.

v3.22.2.2
Long-Term Debt
9 Months Ended
Sep. 30, 2022
Debt Disclosure [Abstract]  
Long-Term Debt

NOTE 7 — LONG-TERM DEBT

A summary of long-term debt at September 30, 2022 and December 31, 2021, including related interest rates at September 30, 2022, follows (dollars in millions):

 

 

 

 

September 30,
2022

 

 

December 31,
2021

 

Senior secured asset-based revolving credit facility (effective interest rate of 4.1%)

$

2,550

 

 

$

2,780

 

Senior secured revolving credit facility

 

 

 

 

 

Senior secured term loan facilities (effective interest rate of 4.3%)

 

1,900

 

 

 

1,960

 

Senior secured notes

 

 

 

 

16,200

 

Other senior secured debt (effective interest rate of 4.1%)

 

917

 

 

 

935

 

Senior secured debt

 

5,367

 

 

 

21,875

 

Senior unsecured notes (effective interest rate of 4.9%)

 

32,652

 

 

 

12,952

 

Debt issuance costs and discounts

 

(309

)

 

 

(248

)

Total debt (average life of 9.9 years, rates averaging 4.8%)

 

37,710

 

 

 

34,579

 

Less amounts due within one year

 

218

 

 

 

237

 

 

$

37,492

 

 

$

34,342

 

 

 

During March 2022, we issued $6.000 billion aggregate principal amount of senior secured notes comprised of (i) $1.000 billion aggregate principal amount of 3 1/8% senior secured notes due 2027, (ii) $500 million aggregate principal amount of 3 3/8% senior secured notes due 2029, (iii) $2.000 billion aggregate principal amount of 3 5/8% senior secured notes due 2032, (iv) $500 million aggregate principal amount of 4 3/8% senior secured notes due 2042 and (v) $2.000 billion aggregate principal amount of 4 5/8% senior secured notes due 2052. During March 2022, we used a portion of the net proceeds to pay down our revolving credit facilities. During the second quarter of 2022, we redeemed all $1.250 billion outstanding aggregate principal amount of our 4.75% senior secured notes due 2023 and all $1.250 billion outstanding aggregate principal amount of our 5.875% senior notes due 2023. The pretax loss on retirement of debt for these two redemptions was $78 million.

 

During May 2022, Standard & Poor's Rating Services ("S&P") announced it had issued an investment grade rating with respect to the issuer credit rating of HCA Healthcare, Inc. and its subsidiaries. S&P's announcement, in conjunction with the Moody's Investors Service, Inc. upgrade in 2021, permitted the permanent release of the subsidiary guarantees and all collateral securing our senior secured notes. As a result of these releases, the senior secured notes are now classified as senior unsecured notes. The subsidiary guarantees and collateral securing our senior secured credit facilities are not affected.

v3.22.2.2
Contingencies
9 Months Ended
Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]  
Contingencies

NOTE 8 — CONTINGENCIES

We operate in a highly regulated and litigious industry. As a result, various lawsuits, claims and legal and regulatory proceedings have been and can be expected to be instituted or asserted against us. We are also subject to claims and suits arising in the ordinary course of business, including claims for personal injuries or wrongful restriction of, or interference with, physicians’ staff privileges. In certain of these actions the claimants may seek punitive damages against us which may not be covered by insurance. We are also subject to claims by various taxing authorities for additional taxes and related interest and penalties. The resolution of any such lawsuits, claims or legal and regulatory proceedings could have a material, adverse effect on our results of operations, financial position or liquidity.

Health care companies are routinely subject to investigations by various governmental agencies. Under the federal False Claims Act (“FCA”), private parties have the right to bring qui tam, or “whistleblower,” suits against companies that submit false claims for payments to, or improperly retain overpayments from, the government. Some states have adopted similar state whistleblower and false claims provisions. Certain of our individual facilities have received, and from time to time, other facilities may receive, government inquiries from, and may be subject to investigation by, federal and state agencies. Depending on whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution could have a material, adverse effect on our results of operations, financial position or liquidity.

 

NOTE 8 — CONTINGENCIES (continued)

Texas operates a state Medicaid program pursuant to a waiver from the Centers for Medicare & Medicaid Services ("CMS") under Section 1115 of the Social Security Act (“Program”). The Program includes uncompensated-care pools; payments from these pools are intended to defray the uncompensated costs of services provided by our and other hospitals to Medicaid eligible or uninsured individuals. Separately, we and other hospitals provide charity care services in several communities in the state. In 2018, the Civil Division of the U.S. Department of Justice and the U.S. Attorney’s Office for the Southern District of Texas requested information about whether the Program, as operated in Harris County, complied with the laws and regulations applicable to provider related donations, and the Company cooperated with that request. On May 21, 2019, a qui tam lawsuit asserting violations of the FCA and the Texas Medicaid Fraud Prevention Act related to the Program, as operated in Harris County, was unsealed by the U.S. District Court for the Southern District of Texas. Both the federal and state governments declined to intervene in the qui tam lawsuit. The Company believes that our participation is and has been consistent with the requirements of the Program and is vigorously defending against the lawsuit being pursued by the relator. We cannot predict what effect, if any, the qui tam lawsuit could have on the Company.
v3.22.2.2
Share Repurchase Transactions and Other Comprehensive Loss
9 Months Ended
Sep. 30, 2022
Federal Home Loan Banks [Abstract]  
Share Repurchases Transactions and Other Comprehensive Loss

NOTE 9 — SHARE REPURCHASE TRANSACTIONS AND OTHER COMPREHENSIVE LOSS

During January 2022 and February 2021, our Board of Directors authorized share repurchase programs for up to $8 billion and $6 billion, respectively, of our outstanding common stock. During the nine months ended September 30, 2022, we repurchased 23.966 million shares of our common stock at an average price of $228.68 per share through market purchases pursuant to the February 2021 authorization (which was completed during the first quarter of 2022) and the January 2022 authorization. At September 30, 2022, we had $3.106 billion of repurchase authorization available under the January 2022 authorization.

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

 

 

Unrealized
Gains (Losses) on
Available-
for-Sale
Securities

 

 

Foreign
Currency
Translation
Adjustments

 

 

Defined
Benefit
Plans

 

 

Change
in Fair
Value of
Derivative
Instruments

 

 

Total

 

Balances at December 31, 2021

 

$

12

 

 

$

(278

)

 

$

(132

)

 

$

(6

)

 

$

(404

)

Unrealized losses on available-for-sale
   securities, net of $
13 income tax benefit

 

 

(45

)

 

 

 

 

 

 

 

 

 

 

 

(45

)

Foreign currency translation adjustments, net
   of $
24 income tax benefit

 

 

 

 

 

(157

)

 

 

 

 

 

 

 

 

(157

)

Change in fair value of derivative instruments,
   net of $
1 of income taxes

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

5

 

Expense reclassified into operations from other
  comprehensive income, net of
none, $2 and $1 
  income tax benefits, respectively

 

1

 

 

 

 

 

 

5

 

 

 

3

 

 

 

9

 

Balances at September 30, 2022

 

$

(32

)

 

$

(435

)

 

$

(127

)

 

$

2

 

 

$

(592

)

v3.22.2.2
Segment and Geographic Information
9 Months Ended
Sep. 30, 2022
Segment Reporting [Abstract]  
Segment and Geographic Information

NOTE 10 — SEGMENT AND GEOGRAPHIC INFORMATION

We operate in one line of business, which is operating hospitals and related health care entities. We operate in two geographically organized groups: the National and American Groups. The National Group includes 96 hospitals located in Alaska, California, Florida, Georgia, Idaho, Indiana, northern Kentucky, Nevada, New Hampshire, North Carolina, South Carolina, Utah and Virginia, and the American Group includes 79 hospitals located in Colorado, Kansas, southern Kentucky, Louisiana, Missouri, Tennessee and Texas. We also operate seven hospitals in England, and these facilities are included in the Corporate and other group.

Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, gains and losses on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2022 and 2021 are summarized in the following table (dollars in millions):

 

 

 

Quarter

 

 

Nine Months

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

7,635

 

 

$

7,787

 

 

$

22,490

 

 

$

22,143

 

American Group

 

 

6,599

 

 

 

6,767

 

 

 

19,872

 

 

 

19,562

 

Corporate and other

 

 

737

 

 

 

722

 

 

 

2,374

 

 

 

1,983

 

 

 

$

14,971

 

 

$

15,276

 

 

$

44,736

 

 

$

43,688

 

Losses (equity) in earnings of affiliates:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

(1

)

 

$

(14

)

 

$

(3

)

 

$

(30

)

American Group

 

 

(13

)

 

 

(14

)

 

 

(31

)

 

 

(38

)

Corporate and other

 

 

4

 

 

 

(7

)

 

 

5

 

 

 

(10

)

 

 

$

(10

)

 

$

(35

)

 

$

(29

)

 

$

(78

)

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

1,550

 

 

$

1,780

 

 

$

4,656

 

 

$

5,330

 

American Group

 

 

1,389

 

 

 

1,604

 

 

 

4,417

 

 

 

4,698

 

Corporate and other

 

 

(37

)

 

 

(160

)

 

 

(185

)

 

 

(533

)

 

 

$

2,902

 

 

$

3,224

 

 

$

8,888

 

 

$

9,495

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

369

 

 

$

343

 

 

$

1,088

 

 

$

1,005

 

American Group

 

 

309

 

 

 

295

 

 

 

914

 

 

 

884

 

Corporate and other

 

 

71

 

 

 

78

 

 

 

217

 

 

 

236

 

 

 

$

749

 

 

$

716

 

 

$

2,219

 

 

$

2,125

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted segment EBITDA

 

$

2,902

 

 

$

3,224

 

 

$

8,888

 

 

$

9,495

 

Depreciation and amortization

 

 

749

 

 

 

716

 

 

 

2,219

 

 

 

2,125

 

Interest expense

 

 

446

 

 

 

398

 

 

 

1,288

 

 

 

1,168

 

Losses (gains) on sales of facilities

 

 

3

 

 

 

(1,047

)

 

 

25

 

 

 

(1,057

)

Losses on retirement of debt

 

 

 

 

 

 

 

 

78

 

 

 

12

 

Income before income taxes

 

$

1,704

 

 

$

3,157

 

 

$

5,278

 

 

$

7,247

 

v3.22.2.2
Basis of Presentation and Significant Accounting Policies (Policies)
9 Months Ended
Sep. 30, 2022
Accounting Policies [Abstract]  
Basis of Presentation

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and footnotes required by generally accepted accounting principles for complete consolidated financial statements. In the opinion of management, all adjustments considered necessary for a fair presentation have been included and are of a normal and recurring nature.

The majority of our expenses are “costs of revenues” items. Costs that could be classified as general and administrative would include our corporate office costs, which were $91 million and $87 million for the quarters ended September 30, 2022 and 2021, respectively, and $281 million and $301 million for the nine months ended September 30, 2022 and 2021, respectively. Operating results for the quarter and nine months ended September 30, 2022 are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. For further information, refer to the consolidated financial statements and footnotes thereto included in our annual report on Form 10-K for the year ended December 31, 2021.

COVID-19

We believe the extent of COVID-19’s impact on our operating results and financial condition has been and could continue to be driven by many factors, most of which are beyond our control and ability to forecast. Because of these uncertainties, we cannot estimate how long or to what extent COVID-19 will impact our operations.

Revenues

Revenues

Our revenues generally relate to contracts with patients in which our performance obligations are to provide health care services to the patients. Revenues are recorded during the period our obligations to provide health care services are satisfied. Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges. Our performance obligations for outpatient services are generally satisfied over a period of less than one day. The contractual relationships with patients, in most cases, also involve a third-party payer (Medicare, Medicaid, managed care health plans and commercial insurance companies, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by (Medicare and Medicaid) or negotiated with (managed care health plans and commercial insurance companies) the third-party payers. The payment arrangements with third-party payers for the services we provide to the related patients typically specify payments at amounts less than our standard charges. Medicare generally pays for inpatient and outpatient services at prospectively determined rates based on clinical, diagnostic and other factors. Services provided to patients having Medicaid coverage are generally paid at prospectively determined rates per discharge, per identified service or per covered member. Agreements with commercial insurance carriers, managed care and preferred provider organizations generally provide for payments based upon predetermined rates per diagnosis, per diem rates or discounted fee-for-service rates. Management continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

Our revenues are based upon the estimated amounts we expect to be entitled to receive from patients and third-party payers. Estimates of contractual adjustments under managed care and commercial insurance plans are based upon the payment terms specified in the related contractual agreements. Revenues related to uninsured patients and uninsured copayment and deductible amounts for patients who have health care coverage may have discounts applied (uninsured discounts and contractual discounts). We also record estimated implicit price concessions (based primarily on historical collection experience) related to uninsured accounts to record these revenues at the estimated amounts we expect to collect. Patients treated at our hospitals for non-elective care, who have income at or below 400% of the federal poverty level, are eligible for charity care. Because we do not pursue collection of amounts determined to qualify as charity care, they are not reported in revenues. Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2022 and 2021 are summarized in the following table (dollars in millions):

 

 

 

Quarter

 

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

2,569

 

 

 

17.2

%

 

$

2,645

 

 

 

17.3

%

Managed Medicare

 

 

2,229

 

 

 

14.9

 

 

 

2,124

 

 

 

13.9

 

Medicaid

 

 

797

 

 

 

5.3

 

 

 

692

 

 

 

4.5

 

Managed Medicaid

 

 

939

 

 

 

6.3

 

 

 

813

 

 

 

5.3

 

Managed care and insurers

 

 

7,184

 

 

 

47.9

 

 

 

7,998

 

 

 

52.4

 

International (managed care and insurers)

 

 

311

 

 

 

2.1

 

 

 

324

 

 

 

2.1

 

Other

 

 

942

 

 

 

6.3

 

 

 

680

 

 

 

4.5

 

Revenues

 

$

14,971

 

 

 

100.0

%

 

$

15,276

 

 

 

100.0

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nine Months

 

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

7,790

 

 

 

17.4

%

 

$

7,816

 

 

 

17.9

%

Managed Medicare

 

 

6,813

 

 

 

15.2

 

 

 

6,281

 

 

 

14.4

 

Medicaid

 

 

1,987

 

 

 

4.4

 

 

 

1,722

 

 

 

3.9

 

Managed Medicaid

 

 

3,003

 

 

 

6.7

 

 

 

2,369

 

 

 

5.4

 

Managed care and insurers

 

 

21,480

 

 

 

48.1

 

 

 

22,300

 

 

 

51.0

 

International (managed care and insurers)

 

 

992

 

 

 

2.2

 

 

 

995

 

 

 

2.3

 

Other

 

 

2,671

 

 

 

6.0

 

 

 

2,205

 

 

 

5.1

 

Revenues

 

$

44,736

 

 

 

100.0

%

 

$

43,688

 

 

 

100.0

%

 

NOTE 1 — BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (continued)

Revenues (continued)

 

To quantify the total impact of the trends related to uninsured patient accounts, we believe it is beneficial to view total uncompensated care, which is comprised of charity care, uninsured discounts and implicit price concessions. A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2022 and 2021 follows (dollars in millions):

 

 

Quarter

 

 

Nine Months

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

12,828

 

 

$

12,803

 

 

$

38,096

 

 

$

36,396

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

11.2

%

 

 

11.8

%

 

 

11.2

%

 

 

11.4

%

Total uncompensated care

 

$

8,050

 

 

$

7,782

 

 

$

23,512

 

 

$

22,299

 

Multiply by the cost-to-charges ratio

 

 

11.2

%

 

 

11.8

%

 

 

11.2

%

 

 

11.4

%

Estimated cost of total uncompensated care

 

$

901

 

 

$

916

 

 

$

2,633

 

 

$

2,542

 

 

The total uncompensated care amounts include charity care of $3.206 billion and $3.509 billion, respectively, and the related estimated costs of charity care were $359 million and $413 million, respectively, for the quarters ended September 30, 2022 and 2021. The total uncompensated care amounts include charity care of $10.281 billion and $10.135 billion, respectively, and the related estimated costs of charity care were $1.151 billion and $1.155 billion, respectively, for the nine months ended September 30, 2022 and 2021.
Reclassifications

Reclassifications

Certain prior year amounts have been reclassified to conform to the current year presentation.
Earnings Per Share We compute basic earnings per share using the weighted average number of common shares outstanding. We compute diluted earnings per share using the weighted average number of common shares outstanding, plus the dilutive effect of outstanding equity awards, computed using the treasury stock method.
Fair Value Measurements and Disclosures

Accounting Standards Codification 820, Fair Value Measurements and Disclosures (“ASC 820”), emphasizes fair value is a market-based measurement, and fair value measurements should be determined based on the assumptions market participants would use in pricing assets or liabilities. ASC 820 utilizes a fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumptions about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).

Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities. Level 2 inputs are inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs may include quoted prices for similar assets and liabilities in active markets, as well as inputs observable for the asset or liability (other than quoted prices), such as interest rates, foreign exchange rates, and yield curves observable at commonly quoted intervals. Level 3 inputs are unobservable inputs for the asset or liability, which are typically based on an entity’s own assumptions, as there is little, if any, related market activity. In instances where the determination of the fair value measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input significant to the fair value measurement in its entirety. Our assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment.
Investment Securities

Investment Securities

The investments of our insurance subsidiaries are generally classified within Level 1 or Level 2 of the fair value hierarchy because they are valued using quoted market prices, broker or dealer quotations, or alternative pricing sources with reasonable levels of price transparency.

Derivative Financial Instruments

Derivative Financial Instrument

We have entered into an interest rate swap agreement to manage our exposure to fluctuations in interest rates. The valuation of this instrument is determined using widely accepted valuation techniques, including a discounted expected cash flow analysis.

v3.22.2.2
Basis of Presentation and Significant Accounting Policies (Tables)
9 Months Ended
Sep. 30, 2022
Accounting Policies [Abstract]  
Schedule of Revenues from Third Party Payers, Uninsured and Other Payers Our revenues by primary third-party payer classification and other (including uninsured patients) for the quarters and nine months ended September 30, 2022 and 2021 are summarized in the following table (dollars in millions):

 

 

 

Quarter

 

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

2,569

 

 

 

17.2

%

 

$

2,645

 

 

 

17.3

%

Managed Medicare

 

 

2,229

 

 

 

14.9

 

 

 

2,124

 

 

 

13.9

 

Medicaid

 

 

797

 

 

 

5.3

 

 

 

692

 

 

 

4.5

 

Managed Medicaid

 

 

939

 

 

 

6.3

 

 

 

813

 

 

 

5.3

 

Managed care and insurers

 

 

7,184

 

 

 

47.9

 

 

 

7,998

 

 

 

52.4

 

International (managed care and insurers)

 

 

311

 

 

 

2.1

 

 

 

324

 

 

 

2.1

 

Other

 

 

942

 

 

 

6.3

 

 

 

680

 

 

 

4.5

 

Revenues

 

$

14,971

 

 

 

100.0

%

 

$

15,276

 

 

 

100.0

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nine Months

 

 

 

2022

 

 

Ratio

 

 

2021

 

 

Ratio

 

Medicare

 

$

7,790

 

 

 

17.4

%

 

$

7,816

 

 

 

17.9

%

Managed Medicare

 

 

6,813

 

 

 

15.2

 

 

 

6,281

 

 

 

14.4

 

Medicaid

 

 

1,987

 

 

 

4.4

 

 

 

1,722

 

 

 

3.9

 

Managed Medicaid

 

 

3,003

 

 

 

6.7

 

 

 

2,369

 

 

 

5.4

 

Managed care and insurers

 

 

21,480

 

 

 

48.1

 

 

 

22,300

 

 

 

51.0

 

International (managed care and insurers)

 

 

992

 

 

 

2.2

 

 

 

995

 

 

 

2.3

 

Other

 

 

2,671

 

 

 

6.0

 

 

 

2,205

 

 

 

5.1

 

Revenues

 

$

44,736

 

 

 

100.0

%

 

$

43,688

 

 

 

100.0

%

 

Schedule of Estimated Cost of Uncompensated Care A summary of the estimated cost of total uncompensated care for the quarters and nine months ended September 30, 2022 and 2021 follows (dollars in millions):

 

 

Quarter

 

 

Nine Months

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Patient care costs (salaries and benefits, supplies, other operating
   expenses and depreciation and amortization)

 

$

12,828

 

 

$

12,803

 

 

$

38,096

 

 

$

36,396

 

Cost-to-charges ratio (patient care costs as percentage of gross
   patient charges)

 

 

11.2

%

 

 

11.8

%

 

 

11.2

%

 

 

11.4

%

Total uncompensated care

 

$

8,050

 

 

$

7,782

 

 

$

23,512

 

 

$

22,299

 

Multiply by the cost-to-charges ratio

 

 

11.2

%

 

 

11.8

%

 

 

11.2

%

 

 

11.4

%

Estimated cost of total uncompensated care

 

$

901

 

 

$

916

 

 

$

2,633

 

 

$

2,542

 

 

v3.22.2.2
Earnings Per Share (Tables)
9 Months Ended
Sep. 30, 2022
Earnings Per Share [Abstract]  
Schedule of Computations of Basic and Diluted Earnings Per Share

The following table sets forth the computation of basic and diluted earnings per share for the quarters and nine months ended September 30, 2022 and 2021 (dollars and shares in millions, except per share amounts):

 

 

 

Quarter

 

 

Nine Months

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Net income attributable to HCA Healthcare, Inc.

 

$

1,134

 

 

$

2,269

 

 

$

3,562

 

 

$

5,142

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weighted average common shares outstanding

 

 

285.958

 

 

 

318.072

 

 

 

293.583

 

 

 

328.048

 

Effect of dilutive incremental shares

 

 

3.894

 

 

 

5.957

 

 

 

4.119

 

 

 

5.200

 

Shares used for diluted earnings per share

 

 

289.852

 

 

 

324.029

 

 

 

297.702

 

 

 

333.248

 

Earnings per share:

 

 

 

 

 

 

 

 

 

 

 

 

Basic earnings

 

$

3.97

 

 

$

7.13

 

 

$

12.13

 

 

$

15.67

 

Diluted earnings

 

$

3.91

 

 

$

7.00

 

 

$

11.97

 

 

$

15.43

 

v3.22.2.2
Investments of Insurance Subsidiaries (Tables)
9 Months Ended
Sep. 30, 2022
Investments, Debt and Equity Securities [Abstract]  
Schedule of Investments

A summary of our insurance subsidiaries’ investments at September 30, 2022 and December 31, 2021 follows (dollars in millions):

 

 

 

September 30, 2022

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

410

 

 

$

 

 

$

(41

)

 

$

369

 

Money market funds and other

 

 

124

 

 

 

 

 

 

 

 

 

124

 

 

 

$

534

 

 

$

 

 

$

(41

)

 

 

493

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(121

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

372

 

 

NOTE 5 — INVESTMENTS OF INSURANCE SUBSIDIARIES (continued)

 

 

 

December 31, 2021

 

 

 

 

 

 

Unrealized
Amounts

 

 

 

 

 

 

Amortized
Cost

 

 

Gains

 

 

Losses

 

 

Fair
Value

 

Debt securities

 

$

400

 

 

$

18

 

 

$

(2

)

 

$

416

 

Money market funds and other

 

 

125

 

 

 

 

 

 

 

 

 

125

 

 

 

$

525

 

 

$

18

 

 

$

(2

)

 

 

541

 

Amounts classified as current assets

 

 

 

 

 

 

 

 

 

 

 

(103

)

Investment carrying value

 

 

 

 

 

 

 

 

 

 

$

438

 

 

Schedule of Maturities of Investments

Scheduled maturities of investments in debt securities at September 30, 2022 were as follows (dollars in millions):

 

 

 

Amortized
Cost

 

 

Fair
Value

 

Due in one year or less

 

$

26

 

 

$

26

 

Due after one year through five years

 

 

127

 

 

 

121

 

Due after five years through ten years

 

 

181

 

 

 

155

 

Due after ten years

 

 

76

 

 

 

67

 

 

 

$

410

 

 

$

369

 

v3.22.2.2
Assets and Liabilities Measured at Fair Value (Tables)
9 Months Ended
Sep. 30, 2022
Fair Value Disclosures [Abstract]  
Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis

The following tables summarize our assets and liabilities measured at fair value on a recurring basis as of September 30, 2022 and December 31, 2021, aggregated by the level in the fair value hierarchy within which those measurements fall (dollars in millions):

 

 

 

September 30, 2022

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Assets:

 

 

 

 

 

 

 

 

 

 

 

 

Investments of insurance subsidiaries:

 

 

 

 

 

 

 

 

 

 

 

 

Debt securities

 

$

369

 

 

$

 

 

$

369

 

 

$

 

Money market funds and other

 

 

124

 

 

 

124

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

493

 

 

 

124

 

 

 

369

 

 

 

 

Less amounts classified as current assets

 

 

(121

)

 

 

(115

)

 

 

(6

)

 

 

 

 

 

$

372

 

 

$

9

 

 

$

363

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interest rate swap (Other current assets)

 

$

2

 

 

$

 

 

$

2

 

 

$

 

 

 

 

 

December 31, 2021

 

 

 

 

 

 

Fair Value Measurements Using

 

 

 

Fair Value

 

 

Quoted Prices in
Active Markets for
Identical Assets
and Liabilities
(Level 1)

 

 

Significant Other
Observable Inputs
(Level 2)

 

 

Significant
Unobservable Inputs
(Level 3)

 

Assets:

 

 

 

 

 

 

 

 

 

 

 

 

Investments of insurance subsidiaries:

 

 

 

 

 

 

 

 

 

 

 

 

Debt securities

 

$

416

 

 

$

 

 

$

416

 

 

$

 

Money market funds and other

 

 

125

 

 

 

125

 

 

 

 

 

 

 

Investments of insurance subsidiaries

 

 

541

 

 

 

125

 

 

 

416

 

 

 

 

Less amounts classified as current assets

 

 

(103

)

 

 

(103

)

 

 

 

 

 

 

 

 

$

438

 

 

$

22

 

 

$

416

 

 

$

 

Liabilities:

 

 

 

 

 

 

 

 

 

 

 

 

Interest rate swap (Other accrued expenses)

 

$

8

 

 

$

 

 

$

8

 

 

$

 

v3.22.2.2
Long-Term Debt (Tables)
9 Months Ended
Sep. 30, 2022
Debt Disclosure [Abstract]  
Schedule of Long-Term Debt

A summary of long-term debt at September 30, 2022 and December 31, 2021, including related interest rates at September 30, 2022, follows (dollars in millions):

 

 

 

 

September 30,
2022

 

 

December 31,
2021

 

Senior secured asset-based revolving credit facility (effective interest rate of 4.1%)

$

2,550

 

 

$

2,780

 

Senior secured revolving credit facility

 

 

 

 

 

Senior secured term loan facilities (effective interest rate of 4.3%)

 

1,900

 

 

 

1,960

 

Senior secured notes

 

 

 

 

16,200

 

Other senior secured debt (effective interest rate of 4.1%)

 

917

 

 

 

935

 

Senior secured debt

 

5,367

 

 

 

21,875

 

Senior unsecured notes (effective interest rate of 4.9%)

 

32,652

 

 

 

12,952

 

Debt issuance costs and discounts

 

(309

)

 

 

(248

)

Total debt (average life of 9.9 years, rates averaging 4.8%)

 

37,710

 

 

 

34,579

 

Less amounts due within one year

 

218

 

 

 

237

 

 

$

37,492

 

 

$

34,342

 

v3.22.2.2
Share Repurchase Transactions and Other Comprehensive Loss (Tables)
9 Months Ended
Sep. 30, 2022
Federal Home Loan Banks [Abstract]  
Components of Accumulated Other Comprehensive Loss

The components of accumulated other comprehensive loss are as follows (dollars in millions):

 

 

 

Unrealized
Gains (Losses) on
Available-
for-Sale
Securities

 

 

Foreign
Currency
Translation
Adjustments

 

 

Defined
Benefit
Plans

 

 

Change
in Fair
Value of
Derivative
Instruments

 

 

Total

 

Balances at December 31, 2021

 

$

12

 

 

$

(278

)

 

$

(132

)

 

$

(6

)

 

$

(404

)

Unrealized losses on available-for-sale
   securities, net of $
13 income tax benefit

 

 

(45

)

 

 

 

 

 

 

 

 

 

 

 

(45

)

Foreign currency translation adjustments, net
   of $
24 income tax benefit

 

 

 

 

 

(157

)

 

 

 

 

 

 

 

 

(157

)

Change in fair value of derivative instruments,
   net of $
1 of income taxes

 

 

 

 

 

 

 

 

 

 

 

5

 

 

 

5

 

Expense reclassified into operations from other
  comprehensive income, net of
none, $2 and $1 
  income tax benefits, respectively

 

1

 

 

 

 

 

 

5

 

 

 

3

 

 

 

9

 

Balances at September 30, 2022

 

$

(32

)

 

$

(435

)

 

$

(127

)

 

$

2

 

 

$

(592

)

v3.22.2.2
Segment and Geographic Information (Tables)
9 Months Ended
Sep. 30, 2022
Segment Reporting [Abstract]  
Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization, Assets and Goodwill and other intangible assets. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA and depreciation and amortization for the quarters and nine months ended September 30, 2022 and 2021 are summarized in the following table (dollars in millions):

 

 

 

Quarter

 

 

Nine Months

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Revenues:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

7,635

 

 

$

7,787

 

 

$

22,490

 

 

$

22,143

 

American Group

 

 

6,599

 

 

 

6,767

 

 

 

19,872

 

 

 

19,562

 

Corporate and other

 

 

737

 

 

 

722

 

 

 

2,374

 

 

 

1,983

 

 

 

$

14,971

 

 

$

15,276

 

 

$

44,736

 

 

$

43,688

 

Losses (equity) in earnings of affiliates:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

(1

)

 

$

(14

)

 

$

(3

)

 

$

(30

)

American Group

 

 

(13

)

 

 

(14

)

 

 

(31

)

 

 

(38

)

Corporate and other

 

 

4

 

 

 

(7

)

 

 

5

 

 

 

(10

)

 

 

$

(10

)

 

$

(35

)

 

$

(29

)

 

$

(78

)

Adjusted segment EBITDA:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

1,550

 

 

$

1,780

 

 

$

4,656

 

 

$

5,330

 

American Group

 

 

1,389

 

 

 

1,604

 

 

 

4,417

 

 

 

4,698

 

Corporate and other

 

 

(37

)

 

 

(160

)

 

 

(185

)

 

 

(533

)

 

 

$

2,902

 

 

$

3,224

 

 

$

8,888

 

 

$

9,495

 

Depreciation and amortization:

 

 

 

 

 

 

 

 

 

 

 

 

National Group

 

$

369

 

 

$

343

 

 

$

1,088

 

 

$

1,005

 

American Group

 

 

309

 

 

 

295

 

 

 

914

 

 

 

884

 

Corporate and other

 

 

71

 

 

 

78

 

 

 

217

 

 

 

236

 

 

 

$

749

 

 

$

716

 

 

$

2,219

 

 

$

2,125

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjusted segment EBITDA

 

$

2,902

 

 

$

3,224

 

 

$

8,888

 

 

$

9,495

 

Depreciation and amortization

 

 

749

 

 

 

716

 

 

 

2,219

 

 

 

2,125

 

Interest expense

 

 

446

 

 

 

398

 

 

 

1,288

 

 

 

1,168

 

Losses (gains) on sales of facilities

 

 

3

 

 

 

(1,047

)

 

 

25

 

 

 

(1,057

)

Losses on retirement of debt

 

 

 

 

 

 

 

 

78

 

 

 

12

 

Income before income taxes

 

$

1,704

 

 

$

3,157

 

 

$

5,278

 

 

$

7,247

 

v3.22.2.2
Basis of Presentation and Significant Accounting Policies - Additional Information (Detail)
$ in Millions
1 Months Ended 3 Months Ended 9 Months Ended
Nov. 30, 2017
Sep. 30, 2022
USD ($)
Hospital
State
EndoscopyCenter
SurgeryCenter
Sep. 30, 2021
USD ($)
Sep. 30, 2022
USD ($)
Hospital
State
EndoscopyCenter
SurgeryCenter
Sep. 30, 2021
USD ($)
Summary Of Significant Accounting Policies [Line Items]          
Number of owned and operated hospitals | Hospital   182   182  
Number of freestanding surgery centers | SurgeryCenter   125   125  
Number of freestanding endoscopy centers | EndoscopyCenter   21   21  
Number of facilities locations | State   20   20  
General and administrative expense   $ 91 $ 87 $ 281 $ 301
Charity care amount   3,206 3,509 10,281 10,135
Estimated costs of charity care   359 413 1,151 1,155
Revenues   $ 14,971 $ 15,276 $ 44,736 $ 43,688
Inpatient Services [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Performance obligations for inpatient/ outpatient services satisfied period       Our performance obligations for inpatient services are generally satisfied over periods that average approximately five days, and revenues are recognized based on charges incurred in relation to total expected charges  
Maximum [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Percentage of income of federal poverty level eligible for charity care 400.00%        
Maximum [Member] | Outpatient Services [Member]          
Summary Of Significant Accounting Policies [Line Items]          
Performance obligations for inpatient/ outpatient services satisfied period       Our performance obligations for outpatient services are generally satisfied over a period of less than one day  
v3.22.2.2
Basis of Presentation and Significant Accounting Policies - Schedule of Revenues from Third Party Payers, Uninsured and Other Payers (Detail) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Revenues From Third Party Payers [Line Items]        
Revenues $ 14,971 $ 15,276 $ 44,736 $ 43,688
Revenues ratio from third party payers 100.00% 100.00% 100.00% 100.00%
Medicare [Member]        
Revenues From Third Party Payers [Line Items]        
Revenues from third party payers $ 2,569 $ 2,645 $ 7,790 $ 7,816
Revenues from third party payers, Ratio 17.20% 17.30% 17.40% 17.90%
Managed Medicare [Member]        
Revenues From Third Party Payers [Line Items]        
Revenues from third party payers $ 2,229 $ 2,124 $ 6,813 $ 6,281
Revenues from third party payers, Ratio 14.90% 13.90% 15.20% 14.40%
Medicaid [Member]        
Revenues From Third Party Payers [Line Items]        
Revenues from third party payers $ 797 $ 692 $ 1,987 $ 1,722
Revenues from third party payers, Ratio 5.30% 4.50% 4.40% 3.90%
Managed Medicaid [Member]        
Revenues From Third Party Payers [Line Items]        
Revenues from third party payers $ 939 $ 813 $ 3,003 $ 2,369
Revenues from third party payers, Ratio 6.30% 5.30% 6.70% 5.40%
Managed Care and Insurers [Member]        
Revenues From Third Party Payers [Line Items]        
Revenues from third party payers $ 7,184 $ 7,998 $ 21,480 $ 22,300
Revenues from third party payers, Ratio 47.90% 52.40% 48.10% 51.00%
International (Managed Care and Insurers) [Member]        
Revenues From Third Party Payers [Line Items]        
Revenues from third party payers $ 311 $ 324 $ 992 $ 995
Revenues from third party payers, Ratio 2.10% 2.10% 2.20% 2.30%
Other [Member]        
Revenues From Third Party Payers [Line Items]        
Revenues $ 942 $ 680 $ 2,671 $ 2,205
Other, Ratio 6.30% 4.50% 6.00% 5.10%
v3.22.2.2
Basis of Presentation and Significant Accounting Policies - Schedule of Estimated Cost of Uncompensated Care (Detail) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Accounting Policies [Abstract]        
Patient care costs (salaries and benefits, supplies, other operating expenses and depreciation and amortization) $ 12,828 $ 12,803 $ 38,096 $ 36,396
Cost-to-charges ratio (patient care costs as percentage of gross patient charges) 11.20% 11.80% 11.20% 11.40%
Total uncompensated care $ 8,050 $ 7,782 $ 23,512 $ 22,299
Multiply by the cost-to-charges ratio 11.20% 11.80% 11.20% 11.40%
Estimated cost of total uncompensated care $ 901 $ 916 $ 2,633 $ 2,542
v3.22.2.2
Acquisitions and Dispositions - Additional Information (Detail)
$ in Millions
9 Months Ended
Sep. 30, 2022
USD ($)
Sep. 30, 2021
USD ($)
Hospital
Business Acquisition [Line Items]    
Proceeds from sale of business $ 652 $ 1,980
Number of hospitals purchased | Hospital   2
Real Estate and Other Investments [Member]    
Business Acquisition [Line Items]    
Proceeds from sale of business 38 $ 473
Pretax gain (loss) before tax 25 402
Discontinued Operations, Disposed of by Sale [Member]    
Business Acquisition [Line Items]    
Proceeds from sale of business 614 647
GEORGIA, REPUBLIC OF | Discontinued Operations, Disposed of by Sale [Member]    
Business Acquisition [Line Items]    
Proceeds from sale of business   860
Pretax gain (loss) before tax   $ 655
Number of hospitals sold | Hospital   4
Southern Georgia [Member] | Discontinued Operations, Disposed of by Sale [Member]    
Business Acquisition [Line Items]    
Number of hospitals sold | Hospital   2
Northern Georgia [Member] | Discontinued Operations, Disposed of by Sale [Member]    
Business Acquisition [Line Items]    
Number of hospitals sold | Hospital   2
Nonhospital Health Care [Member]    
Business Acquisition [Line Items]    
Aggregate purchase price $ 176 $ 91
Home Health and Hospice [Member]    
Business Acquisition [Line Items]    
Payment to acquire venture providing post acute care services   330
Business acquisition percentage of voting interests acquired 80.00%  
Hospital [Member]    
Business Acquisition [Line Items]    
Aggregate purchase price   $ 67
Hospital [Member] | TENNESSEE    
Business Acquisition [Line Items]    
Number of hospitals purchased | Hospital   1
Hospital [Member] | Southern Georgia [Member]    
Business Acquisition [Line Items]    
Number of hospitals purchased | Hospital   1
v3.22.2.2
Income Taxes - Additional Information (Detail) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Dec. 31, 2021
Income Tax Disclosure [Abstract]          
Provision for income taxes $ 360 $ 685 $ 1,090 $ 1,531  
Effective tax rate 24.10% 23.20% 23.40% 22.90%  
Provision for tax benefits related to settlement of employee awards     $ 70 $ 96  
Liability for unrecognized tax benefits $ 670   670   $ 642
Unrecognized tax benefits, accrued interest 116   116   99
Unrecognized tax benefits that would impact effective tax rate $ 246   $ 246   $ 217
v3.22.2.2
Earnings Per Share - Schedule of Computations of Basic and Diluted Earnings Per Share (Detail) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Earnings Per Share [Abstract]        
Net income attributable to HCA Healthcare, Inc. $ 1,134 $ 2,269 $ 3,562 $ 5,142
Weighted average common shares outstanding 285,958 318,072 293,583 328,048
Effect of dilutive incremental shares 3,894 5,957 4,119 5,200
Shares used for diluted earnings per share 289,852 324,029 297,702 333,248
Basic earnings per share $ 3.97 $ 7.13 $ 12.13 $ 15.67
Diluted earnings per share $ 3.91 $ 7.00 $ 11.97 $ 15.43
v3.22.2.2
Investments of Insurance Subsidiaries - Schedule of Investments (Detail) - USD ($)
$ in Millions
Sep. 30, 2022
Dec. 31, 2021
Debt Securities, Available-for-sale [Line Items]    
Amounts classified as current assets $ (121) $ (103)
Investment carrying value 372 438
Amortized Cost 534 525
Unrealized Amounts, Gains   18
Unrealized Amounts, Losses (41) (2)
Fair Value 493 541
Money Market Funds and Other [Member]    
Debt Securities, Available-for-sale [Line Items]    
Amortized Cost 124 125
Fair Value 124 125
Debt Securities [Member]    
Debt Securities, Available-for-sale [Line Items]    
Fair Value 369 416
Debt Securities [Member] | States and Municipalities [Member]    
Debt Securities, Available-for-sale [Line Items]    
Amortized Cost 410 400
Unrealized Amounts, Gains   18
Unrealized Amounts, Losses (41) (2)
Fair Value $ 369 $ 416
v3.22.2.2
Investments of Insurance Subsidiaries - Schedule of Maturities of Investments (Detail)
$ in Millions
Sep. 30, 2022
USD ($)
Investments, Debt and Equity Securities [Abstract]  
Due in one year or less, Amortized Cost $ 26
Due after one year through five years, Amortized Cost 127
Due after five years through ten years, Amortized Cost 181
Due after ten years, Amortized Cost 76
Amortized Cost, Total 410
Due in one year or less, Fair Value 26
Due after one year through five years, Fair Value 121
Due after five years through ten years, Fair Value 155
Due after ten years, Fair Value 67
Fair Value, Total $ 369
v3.22.2.2
Investments of Insurance Subsidiaries - Additional Information (Detail)
9 Months Ended
Sep. 30, 2022
Investments, Debt and Equity Securities [Abstract]  
Available for sale securities expected maturity of debt securities 5 years 9 months 18 days
Available for sale securities average scheduled maturity 8 years 8 months 12 days
v3.22.2.2
Assets and Liabilities Measured at Fair Value - Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis (Detail) - USD ($)
$ in Millions
Sep. 30, 2022
Dec. 31, 2021
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Less amounts classified as current assets $ (121) $ (103)
Investments of insurance subsidiaries 493 541
Investments of insurance subsidiaries, noncurrent 372 438
Money Market Funds and Other [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Fair Value 124 125
Debt Securities [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt Securities, Available-for-sale Securities 369 416
Interest Rate Swaps [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Derivative Liability 2 8
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Less amounts classified as current assets (115) (103)
Investments of insurance subsidiaries 124 125
Investments of insurance subsidiaries, noncurrent 9 22
Quoted Prices in Active Markets for Identical Assets and Liabilities (Level 1) [Member] | Money Market Funds and Other [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Fair Value 124 125
Significant Other Observable Inputs (Level 2) [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Less amounts classified as current assets (6)  
Investments of insurance subsidiaries 369 416
Investments of insurance subsidiaries, noncurrent 363 416
Significant Other Observable Inputs (Level 2) [Member] | Debt Securities [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Debt Securities, Available-for-sale Securities 369 416
Significant Other Observable Inputs (Level 2) [Member] | Interest Rate Swaps [Member]    
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]    
Derivative Liability $ 2 $ 8
v3.22.2.2
Assets and Liabilities Measured at Fair Value - Additional Information (Detail) - USD ($)
$ in Millions
Sep. 30, 2022
Dec. 31, 2021
Fair Value Disclosures [Abstract]    
Estimated fair value of debt $ 34,293 $ 38,541
Carrying amounts of debt $ 38,019 $ 34,827
v3.22.2.2
Long-Term Debt - Schedule of Long-Term Debt (Detail) - USD ($)
$ in Millions
Sep. 30, 2022
Dec. 31, 2021
Debt Instrument [Line Items]    
Senior secured debt $ 5,367 $ 21,875
Debt issuance costs and discounts (309) (248)
Total debt (average life of 9.9 years, rates averaging 4.8%) 37,710 34,579
Less amounts due within one year 218 237
Long-term debt 37,492 34,342
Senior Secured Asset-Based Revolving Credit Facility [Member]    
Debt Instrument [Line Items]    
Long-term line of credit 2,550 2,780
Senior Secured Revolving Credit Facility [Member]    
Debt Instrument [Line Items]    
Long-term line of credit 0 0
Senior Secured Term Loan Facilities [Member]    
Debt Instrument [Line Items]    
Senior secured debt 1,900 1,960
Senior Secured Notes [Member]    
Debt Instrument [Line Items]    
Senior secured debt 0 16,200
Other Senior Secured Debt [Member]    
Debt Instrument [Line Items]    
Other senior secured debt 917 935
Senior Unsecured Notes [Member]    
Debt Instrument [Line Items]    
Senior unsecured notes $ 32,652 $ 12,952
v3.22.2.2
Long-Term Debt - Schedule of Long-Term Debt (Parenthetical) (Detail)
9 Months Ended
Sep. 30, 2022
Debt Instrument [Line Items]  
Total debt average term 9 years 10 months 24 days
Total debt average rate 4.80%
Senior Secured Asset-Based Revolving Credit Facility [Member]  
Debt Instrument [Line Items]  
Effective interest rate 4.10%
Senior Secured Term Loan Facilities [Member]  
Debt Instrument [Line Items]  
Effective interest rate 4.30%
Other Senior Secured Debt [Member]  
Debt Instrument [Line Items]  
Effective interest rate 4.10%
Senior Unsecured Notes [Member]  
Debt Instrument [Line Items]  
Effective interest rate 4.90%
v3.22.2.2
Long-Term Debt - Additional Information (Detail) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Jun. 30, 2022
Mar. 31, 2022
Debt Instrument [Line Items]            
Gain (loss) on extinguishment of debt $ (0) $ (0) $ (78) $ (12)    
Senior Notes Due 2023 [Member]            
Debt Instrument [Line Items]            
Debt instrument, stated interest         5.875%  
Debt instrument, redemption principal amount         $ 1,250  
Senior Notes [Member]            
Debt Instrument [Line Items]            
Debt instrument, principal amount           $ 6,000
Senior Notes [Member] | Senior Secured Notes Due 2027 [Member]            
Debt Instrument [Line Items]            
Debt instrument, principal amount           $ 1,000
Debt instrument, stated interest           3.125%
Senior Notes [Member] | Senior Secured Notes Due 2029 [Member]            
Debt Instrument [Line Items]            
Debt instrument, principal amount           $ 500
Debt instrument, stated interest           3.375%
Senior Notes [Member] | Senior Secured Notes Due 2032 [Member]            
Debt Instrument [Line Items]            
Debt instrument, principal amount           $ 2,000
Debt instrument, stated interest           3.625%
Senior Notes [Member] | Senior Secured Notes Due 2042 [Member]            
Debt Instrument [Line Items]            
Debt instrument, principal amount           $ 500
Debt instrument, stated interest           4.375%
Senior Notes [Member] | Senior Secured Notes Due 2052 [Member]            
Debt Instrument [Line Items]            
Debt instrument, principal amount           $ 2,000
Debt instrument, stated interest           4.625%
Senior Notes [Member] | Senior Secured Notes Due 2023 [Member]            
Debt Instrument [Line Items]            
Debt instrument, stated interest         4.75%  
Debt instrument, redemption principal amount         $ 1,250  
v3.22.2.2
Share Repurchase Transactions and Other Comprehensive Loss - Additional Information (Detail) - USD ($)
$ / shares in Units, $ in Millions
9 Months Ended
Sep. 30, 2022
Jan. 31, 2022
Feb. 28, 2021
Repurchase of common stock, shares 23,966,000    
Repurchase price of common stock, per share $ 228.68    
Board of Directors Chairman [Member]      
Share repurchase program authorized amount $ 3,106 $ 8,000 $ 6,000
v3.22.2.2
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Detail)
$ in Millions
9 Months Ended
Sep. 30, 2022
USD ($)
Equity [Abstract]  
Unrealized gains (losses) on available-for-sale securities, beginning balances $ 12
Unrealized losses on available-for-sale securities, net of income tax benefit (45)
Unrealized gains (losses) on available-for-sale securities, expense reclassified into operations from other comprehensive income, net of income tax benefit 1
Unrealized gains (losses) on available-for-sale securities, ending balances (32)
Foreign currency translation adjustments, beginning balances (278)
Foreign currency translation adjustments, net of income tax benefit (157)
Foreign currency translation adjustments, ending balances (435)
Defined benefit plans, beginning balances (132)
Defined benefit plans, expense reclassified into operations from other comprehensive income 5
Defined benefit plans, ending balances (127)
Change in fair value of derivative instruments, beginning balances (6)
Change in fair value of derivative instruments, net of income taxes 5
Change in fair value of derivatives instruments, expense reclassified into operations from other comprehensive income 3
Change in fair value of derivative instruments, ending balances 2
Accumulated other comprehensive loss, net of tax, beginning balances (404)
Unrealized losses on available-for-sale securities, net of income tax benefit (45)
Foreign currency translation adjustments, net of income tax benefit (157)
Change in fair value of derivative instruments, net of income tax benefit 5
Expense reclassified into operations from other comprehensive income, Total 9
Accumulated other comprehensive loss, net of tax, ending balances $ (592)
v3.22.2.2
Share Repurchase Transactions and Other Comprehensive Loss - Components of Accumulated Other Comprehensive Loss (Parenthetical) (Detail)
$ in Millions
9 Months Ended
Sep. 30, 2022
USD ($)
Equity [Abstract]  
Unrealized losses on available-for-sale securities, tax benefit $ 13
Foreign currency translation adjustments, income tax benefit 24
Change in fair value of derivative instruments, income taxes 1
Unrealized gains (losses) on available-for-sale securities, benefit reclassified into operations from other comprehensive income 0
Defined benefit plans, benefit reclassified into operations from other comprehensive income 2
Interest expense on derivative instruments, benefit reclassified into operations from other comprehensive income $ 1
v3.22.2.2
Segment and Geographic Information - Additional Information (Detail)
9 Months Ended
Sep. 30, 2022
Hospital
Segment Reporting Information [Line Items]  
Number of geographically organized groups 2
Number of owned and operated hospitals 182
Reorganization Group [Member] | National Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 96
Reorganization Group [Member] | American Group [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 79
Reorganization Group [Member] | Corporate and Other [Member]  
Segment Reporting Information [Line Items]  
Number of owned and operated hospitals 7
v3.22.2.2
Segment and Geographic Information - Schedule of Geographic Distributions of Revenues, Equity in Earnings of Affiliates, Adjusted Segment EBITDA, Depreciation and Amortization and Assets (Detail) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Segment Reporting Information [Line Items]        
Revenues $ 14,971 $ 15,276 $ 44,736 $ 43,688
Losses (equity) in earnings of affiliates (10) (35) (29) (78)
Adjusted segment EBITDA 2,902 3,224 8,888 9,495
Depreciation and amortization 749 716 2,219 2,125
Interest expense 446 398 1,288 1,168
Losses (gains) on sales of facilities 3 (1,047) 25 (1,057)
Losses on retirement of debt 0 0 78 12
Income before income taxes 1,704 3,157 5,278 7,247
National Group [Member]        
Segment Reporting Information [Line Items]        
Revenues 7,635 7,787 22,490 22,143
Losses (equity) in earnings of affiliates (1) (14) (3) (30)
Adjusted segment EBITDA 1,550 1,780 4,656 5,330
Depreciation and amortization 369 343 1,088 1,005
American Group [Member]        
Segment Reporting Information [Line Items]        
Revenues 6,599 6,767 19,872 19,562
Losses (equity) in earnings of affiliates (13) (14) (31) (38)
Adjusted segment EBITDA 1,389 1,604 4,417 4,698
Depreciation and amortization 309 295 914 884
Corporate and Other [Member]        
Segment Reporting Information [Line Items]        
Revenues 737 722 2,374 1,983
Losses (equity) in earnings of affiliates 4 (7) 5 (10)
Adjusted segment EBITDA (37) (160) (185) (533)
Depreciation and amortization $ 71 $ 78 $ 217 $ 236