HCA Healthcare Inc. (NYSE:HCA), recognized as one of the largest hospital operators in the United States, announced its fourth-quarter 2025 financial results on Tuesday, presenting a mixture of growth metrics and some areas lagging analysts' forecasts.
The company's total revenue was reported at $19.513 billion for the quarter, reflecting a year-over-year increase of 6.7%. However, this figure fell short of the consensus estimate of $19.67 billion, indicating a slight revenue miss. Despite this, HCA Healthcare demonstrated robust profitability gains during the period.
Adjusted earnings per share reached $8.01, a significant rise from $6.22 recorded in the same period the previous year, and notably above the analyst consensus of $7.43. Correspondingly, net income for the quarter climbed to $1.878 billion, or $8.14 per diluted share, compared to $1.438 billion, or $5.63 per share, in Q4 2024. The reported results for the last quarter of 2025 included gains on asset sales totaling $41 million, or $0.13 per diluted share, primarily stemming from the disposition of a hospital facility located in Indiana.
Examining operational performance, HCA Healthcare saw same-facility admissions grow by 2.4%, with same-facility equivalent admissions increasing slightly higher at 2.5%. Emergency room visits on a same-facility basis inched up by 0.5%, while inpatient surgeries remained stable compared to the year prior. Outpatient surgeries experienced a minor decline of 0.5% in the quarter.
Adjusted EBITDA for the fourth quarter stood at $4.114 billion, up from $3.712 billion one year earlier, reflecting enhanced earnings before interest, taxes, depreciation, and amortization. However, cash flows from operating activities fell to $2.359 billion, down from $2.559 billion in the corresponding quarter of 2024.
Sam Hazen, CEO of HCA Healthcare, commented on the quarterly performance: "We finished 2025 with strong performance consistent with previous quarters. Our investments in network expansion, workforce development, and advancing clinical capabilities further strengthened the HCA Healthcare system." This statement underscores the company's strategy to reinforce its operational foundation despite mixed financial metrics.
Alongside releasing these quarterly results, HCA Healthcare approved an additional share repurchase program capped at $10 billion. Notably, this buyback authorization equates to nearly 10% of HCA Healthcare’s current market capitalization, valued at approximately $103 billion. Such a significant buyback signals management's confidence in the company's valuation and future cash flow generation.
Looking ahead, the company provided its fiscal 2026 forecasts, projecting earnings per share in the range of $29.10 to $31.50. This outlook marginally brackets the consensus estimate of $29.54 per share. Sales revenues for 2026 are anticipated between $76.5 billion and $80 billion, with analysts estimating $79.08 billion.
HCA also expects adjusted EBITDA for the upcoming fiscal year to fall within $15.55 billion to $16.45 billion and forecasts net income ranging from $6.495 billion to $7.035 billion.
During the earnings call, executives highlighted potential headwinds, including an anticipated adverse effect of $600 million to $900 million stemming from impacts related to health insurance exchanges. Additionally, a decline in net benefit from supplemental payments estimated between $250 million and $450 million was discussed as a risk to future earnings.
Following the announcement, shares of HCA Healthcare gained significantly, rising by 11.29% to $525.69, reaching a new 52-week high based on trading data at the time of publication. This market reaction reflects investor approval of the earnings beat and the sizable stock repurchase plan.
In summary, while HCA Healthcare’s revenues modestly missed analyst expectations in Q4 2025, the company delivered strong earnings growth and operational advancements. The announcement of a $10 billion stock buyback program further demonstrates confidence in financial strength and shareholder value creation. Investors should weigh these factors alongside potential earnings pressures tied to policy changes and payment reductions as projected in the upcoming fiscal year.