Full Press Release Details
| INVESTOR CONTACT: | FOR IMMEDIATE RELEASE MEDIA CONTACT: | |
| Frank Morgan | Harlow Sumerford | |
| 615-344-2688 | 615-344-1851 |
HCA Healthcare Reports Second Quarter 2022 Results
Nashville, Tenn., July 22, 2022 HCA Healthcare, Inc. (NYSE: HCA) today announced financial and operating results for the second quarter ended June 30, 2022.
Key second quarter metrics (all percentage changes compare 2Q 2022 to 2Q 2021 unless otherwise noted):
Many aspects of our business were positive considering the challenges we faced with the labor market and other inflationary pressures on costs, said Sam Hazen, Chief Executive Officer of HCA Healthcare. Our teams executed well as they have in the past through other difficult environments. Again, I want to thank them for their dedication and excellent work.
Revenues in the second quarter of 2022 increased to $14.820 billion, compared to $14.435 billion in the second quarter of 2021. Net income attributable to HCA Healthcare, Inc. totaled $1.155 billion, or $3.90 per diluted share, compared to $1.450 billion, or $4.36 per diluted share, in the second quarter of 2021. The second quarter of 2022 results include losses on sales of facilities of $32 million, or $0.11 per diluted share, and losses on retirement of debt of $78 million, or $0.20 per diluted share. The second quarter of 2021 results included gains on sales of facilities of $8 million, or $0.02 per diluted share, and losses on retirement of debt of $12 million, or $0.03 per diluted share.
For the second quarter of 2022, Adjusted EBITDA totaled $3.042 billion, compared to $3.219 billion in the second quarter of 2021. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.
Same facility admissions declined 1.2 percent and same facility equivalent admissions increased 0.5 percent in the second quarter of 2022, compared to the prior year period. Same facility emergency room visits increased 7.3 percent in the second quarter of 2022, compared to the prior year period. Same facility inpatient surgeries
declined 2.3 percent while same facility outpatient surgeries declined 1.4 percent in the second quarter of 2022, compared to the same period of 2021. Same facility revenue per equivalent admission increased 3.5 percent in the second quarter of 2022, compared to the second quarter of 2021.
Six Months Ended June 30, 2022
Revenues for the six months ended June 30, 2022 totaled $29.765 billion, compared to $28.412 billion in the same period of 2021. Net income attributable to HCA Healthcare, Inc. was $2.428 billion, or $8.05 per diluted share, compared to $2.873 billion, or $8.50 per diluted share, for the first six months of 2021. Results for the six months ended June 30, 2022 include losses on sales of facilities of $22 million, or $0.08 per diluted share, and losses on retirement of debt of $78 million, or $0.20 per diluted share. Results for the six months ended June 30, 2021 included gains on sales of facilities of $10 million, or $0.02 per diluted share, and losses on retirement of debt of $12 million, or $0.03 per diluted share.
Balance Sheet and Cash Flows from Operations
As of June 30, 2022, HCA Healthcare, Inc. s balance sheet reflected cash and cash equivalents of $858 million, total debt of $38.903 billion, and total assets of $51.584 billion. During the second quarter of 2022, capital expenditures totaled $1.080 billion, excluding acquisitions. Cash flows provided by operating activities in the second quarter totaled $1.630 billion, compared to $2.251 billion in the second quarter of 2021.
During the second quarter of 2022, the Company repurchased 12.230 million shares of its common stock at a cost of $2.682 billion. The Company had $3.803 billion remaining under its repurchase authorization as of June 30, 2022. As of June 30, 2022, the Company had $2.725 billion of availability under its credit facilities.
HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.56 per share on the Company s common stock. The dividend will be paid on September 30, 2022 to stockholders of record at the close of business on September 16, 2022.
The declaration and payment of any future dividend will be subject to the discretion of the Board of Directors and will depend on a variety of factors, including the Company s financial condition and results of operations and contractual restrictions. Future dividends are expected to be funded by cash balances and future cash flows from operations.
Earnings Conference Call
HCA Healthcare will host a conference call for investors at 8:00 a.m. Central Daylight Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon. The webcast can be accessed through the Company s Investor Relations web page at https://investor.hcahealthcare.com/events-and-presentations/default.aspx.
About the Company
As of June 30, 2022, HCA operated 182 hospitals and approximately 2,300 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 20 states and the United Kingdom.
Forward-Looking Statements
This press release contains forward-looking statements within the meaning of the federal securities laws, which involve risks and uncertainties. Forward-looking statements include statements that do not relate solely to historical or current facts. Forward-looking statements can be identified by the use of words like may, believe, will, expect, project, estimate, anticipate, plan, initiative or continue. These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) developments related to COVID-19, including, without limitation, the length and severity of its impact and the spread of virus strains with new epidemiological characteristics; the volume of canceled or rescheduled procedures and the volume and acuity of COVID-19 patients cared for across our health systems; measures we are taking to respond to COVID-19; the impact and terms of government and administrative regulation and stimulus and relief measures (including the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security ( CARES ) Act, the Paycheck Protection Program and Health Care Enhancement Act, the Consolidated Appropriations Act, 2021, the American Rescue Plan Act of 2021 ( ARPA ) and other enacted and potential future legislation) and whether various stimulus and relief programs continue or new similar programs are enacted in the future; changes in revenues due to declining patient volumes, changes in payer mix and deteriorating macroeconomic conditions (including increases in uninsured and underinsured patients); potential increased expenses related to labor, supply chain or other expenditures; workforce disruptions, including the impact of any current or future vaccine mandates; supply shortages and disruptions; and the timing, availability and adoption of effective medical treatments and vaccines (including boosters), (2) the impact of our substantial indebtedness and the ability to refinance such indebtedness on acceptable terms, (3) the impact of current and future federal and state health reform initiatives and possible changes to other federal, state or local laws and regulations affecting the health care industry, including but not limited to, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively, the Affordable Care Act ), and the effects of additional changes to the Affordable Care Act, its implementation, or interpretation (including through executive orders and court challenges), and proposals to expand coverage of federally-funded insurance programs as an alternative to private insurance or establish a single-payer system (such reforms often referred to as Medicare for All ), and also including any such laws or governmental regulations which are adopted in response to COVID-19, (4) the effects related to the implementation of sequestration spending reductions required under the Budget Control Act of 2011, related legislation extending these reductions and those required under the Pay-As-You-Go Act of 2010 ( PAYGO Act ) as a result of the federal budget deficit impact of the ARPA, and the potential for future deficit reduction legislation that may alter these spending reductions, which include cuts to Medicare payments, or create additional spending reductions, (5) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (6) the ability to achieve operating and financial targets, and attain expected levels of patient volumes and control the costs of providing services, (7) possible changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs or Medicaid waiver programs, that may impact reimbursements to health care providers and insurers and the size of the uninsured or underinsured population, (8) increases in
wages and the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical and technical support personnel, (9) the highly competitive nature of the health care business, (10) changes in service mix, revenue mix and surgical volumes, including potential declines in the population covered under third-party payer agreements, the ability to enter into and renew third-party payer provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (11) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (12) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (13) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (14) changes in accounting practices, (15) changes in general economic conditions nationally and regionally in our markets, including inflation and economic and business conditions (and the impact thereof on the economy and financial markets) resulting from COVID-19 or other factors, (16) the emergence of and effects related to pandemics, epidemics and infectious diseases, (17) future divestitures which may result in charges and possible impairments of long-lived assets, (18) changes in business strategy or development plans, (19) delays in receiving payments for services provided, (20) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (21) potential adverse impact of known and unknown government investigations, litigation and other claims that may be made against us, (22) the impact of potential cybersecurity incidents or security breaches, (23) our ongoing ability to demonstrate meaningful use of certified electronic health record ( EHR ) technology and the impact of interoperability requirements, (24) the impact of natural disasters, such as hurricanes and floods, physical risks from climate change or similar events beyond our control, (25) changes in U.S. federal, state, or foreign tax laws including interpretive guidance that may be issued by taxing authorities or other standard setting bodies, and (26) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2021 and our other filings with the Securities and Exchange Commission. Many of the factors that will determine our future results are beyond our ability to control or predict. In light of the significant uncertainties inherent in the forward-looking statements contained herein, readers should not place undue reliance on forward-looking statements, which reflect management s views only as of the date hereof. We undertake no obligation to revise or update any forward-looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise.
All references to Company and HCA Healthcare as used throughout this release refer to HCA Healthcare, Inc. and its affiliates.
HCA Healthcare, Inc.
Condensed Consolidated Comprehensive Income Statements
(Dollars in millions, except per share amounts)
| 2022 | 2021 | |||||||||||||||
| Amount | Ratio | Amount | Ratio | |||||||||||||
| Revenues | $ | 14,820 | 100.0 | % | $ | 14,435 | 100.0 | % | ||||||||
| Salaries and benefits | 6,792 | 45.8 | 6,385 | 44.2 | ||||||||||||
| Supplies | 2,301 | 15.5 | 2,380 | 16.5 | ||||||||||||
| Other operating expenses | 2,693 | 18.3 | 2,473 | 17.2 | ||||||||||||
| Equity in earnings of affiliates | (8 | ) | (0.1 | ) | (22 | ) | (0.2 | ) | ||||||||
| Depreciation and amortization | 738 | 5.0 | 712 | 4.9 | ||||||||||||
| Interest expense | 434 | 2.9 | 386 | 2.7 | ||||||||||||
| Losses (gains) on sales of facilities | 32 | 0.2 | (8 | ) | (0.1 | ) | ||||||||||
| Losses on retirement of debt | 78 | 0.5 | 12 | 0.1 | ||||||||||||
| 13,060 | 88.1 | 12,318 | 85.3 | |||||||||||||
| Income before income taxes | 1,760 | 11.9 | 2,117 | 14.7 | ||||||||||||
| Provision for income taxes | 381 | 2.6 | 453 | 3.2 | ||||||||||||
| Net income | 1,379 | 9.3 | 1,664 | 11.5 | ||||||||||||
| Net income attributable to noncontrolling interests | 224 | 1.5 | 214 | 1.5 | ||||||||||||
| Net income attributable to HCA Healthcare, Inc. | $ | 1,155 | 7.8 | $ | 1,450 | 10.0 | ||||||||||
| Diluted earnings per share | $ | 3.90 | $ | 4.36 | ||||||||||||
| Shares used in computing diluted earnings per share (millions) | 296.061 | 332.613 | ||||||||||||||
| Comprehensive income attributable to HCA Healthcare, Inc. | $ | 1,087 | $ | 1,466 |
HCA Healthcare, Inc.
Condensed Consolidated Comprehensive Income Statements
For the Six Months Ended June 30, 2022 and 2021
(Dollars in millions, except per share amounts)
| 2022 | 2021 | |||||||||||||||
| Amount | Ratio | Amount | Ratio | |||||||||||||
| Revenues | $ | 29,765 | 100.0 | % | $ | 28,412 | 100.0 | % | ||||||||
| Salaries and benefits | 13,731 | 46.1 | 12,686 | 44.6 | ||||||||||||
| Supplies | 4,622 | 15.5 | 4,604 | 16.2 | ||||||||||||
| Other operating expenses | 5,445 | 18.4 | 4,894 | 17.3 | ||||||||||||
| Equity in earnings of affiliates | (19 | ) | (0.1 | ) | (43 | ) | (0.2 | ) | ||||||||
| Depreciation and amortization | 1,470 | 4.9 | 1,409 | 5.0 | ||||||||||||
| Interest expense | 842 | 2.8 | 770 | 2.7 | ||||||||||||
| Losses (gains) on sales of facilities | 22 | 0.1 | (10 | ) | ||||||||||||
| Losses on retirement of debt | 78 | 0.3 | 12 | |||||||||||||
| 26,191 | 88.0 | 24,322 | 85.6 | |||||||||||||
| Income before income taxes | 3,574 | 12.0 | 4,090 | 14.4 | ||||||||||||
| Provision for income taxes | 730 | 2.4 | 846 | 3.0 | ||||||||||||
| Net income | 2,844 | 9.6 | 3,244 | 11.4 | ||||||||||||
| Net income attributable to noncontrolling interests | 416 | 1.4 | 371 | 1.3 | ||||||||||||
| Net income attributable to HCA Healthcare, Inc. | $ | 2,428 | 8.2 | $ | 2,873 | 10.1 | ||||||||||
| Diluted earnings per share | $ | 8.05 | $ | 8.50 | ||||||||||||
| Shares used in computing diluted earnings per share (millions) | 301.690 | 337.940 | ||||||||||||||
| Comprehensive income attributable to HCA Healthcare, Inc. | $ | 2,317 | $ | 2,900 |
HCA Healthcare, Inc.
Condensed Consolidated Balance Sheets
(Dollars in millions)
| June 30, 2022 | March 31, 2022 | December 31, 2021 | ||||||||||
| ASSETS | ||||||||||||
| Current assets: | ||||||||||||
| Cash and cash equivalents | $ | 858 | $ | 2,371 | $ | 1,451 | ||||||
| Accounts receivable | 8,628 | 8,520 | 8,095 | |||||||||
| Inventories | 2,043 | 2,003 | 1,986 | |||||||||
| Other | 2,408 | 2,112 | 2,010 | |||||||||
| 13,937 | 15,006 | 13,542 | ||||||||||
| Property and equipment, at cost | 52,816 | 52,042 | 51,350 | |||||||||
| Accumulated depreciation | (28,229 | ) | (27,814 | ) | (27,287 | ) | ||||||
| 24,587 | 24,228 | 24,063 | ||||||||||
| Investments of insurance subsidiaries | 379 | 408 | 438 | |||||||||
| Investments in and advances to affiliates | 435 | 441 | 448 | |||||||||
| Goodwill and other intangible assets | 9,593 | 9,525 | 9,540 | |||||||||
| Right-of-use operating lease assets | 2,139 | 2,138 | 2,113 | |||||||||
| Other | 514 | 462 | 598 | |||||||||
| $ | 51,584 | $ | 52,208 | $ | 50,742 | |||||||
| LIABILITIES AND STOCKHOLDERS EQUITY | ||||||||||||
| Current liabilities: | ||||||||||||
| Accounts payable | $ | 3,742 | $ | 4,010 | $ | 4,111 | ||||||
| Accrued salaries | 1,895 | 1,865 | 1,912 | |||||||||
| Other accrued expenses | 3,116 | 3,157 | 3,322 | |||||||||
| Long-term debt due within one year | 246 | 1,486 | 237 | |||||||||
| 8,999 | 10,518 | 9,582 | ||||||||||
| Long-term debt, less debt issuance costs and discounts of $316, $323 and $248 | 38,657 | 36,210 | 34,342 | |||||||||
| Professional liability risks | 1,533 | 1,508 | 1,514 | |||||||||
| Right-of-use operating lease obligations | 1,796 | 1,790 | 1,755 | |||||||||
| Income taxes and other liabilities | 1,741 | 1,768 | 2,060 | |||||||||
| Stockholders (deficit) equity: | ||||||||||||
| Stockholders deficit attributable to HCA Healthcare, Inc. | (3,680 | ) | (2,033 | ) | (933 | ) | ||||||
| Noncontrolling interests | 2,538 | 2,447 | 2,422 | |||||||||
| (1,142 | ) | 414 | 1,489 | |||||||||
| $ | 51,584 | $ | 52,208 | $ | 50,742 |
HCA Healthcare, Inc.
Condensed Consolidated Statements of Cash Flows
For the Six Months Ended June 30, 2022 and 2021
(Dollars in millions)
| 2022 | 2021 | |||||||
| Cash flows from operating activities: | ||||||||
| Net income | $ | 2,844 | $ | 3,244 | ||||
| Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||
| Increase (decrease) in cash from operating assets and liabilities: | ||||||||
| Accounts receivable | (547 | ) | (567 | ) | ||||
| Inventories and other assets | (462 | ) | (213 | ) | ||||
| Accounts payable and accrued expenses | (818 | ) | 49 | |||||
| Depreciation and amortization | 1,470 | 1,409 | ||||||
| Income taxes | 121 | 2 | ||||||
| Losses (gains) on sales of facilities | 22 | (10 | ) | |||||
| Losses on retirement of debt | 78 | 12 | ||||||
| Amortization of debt issuance costs and discounts | 15 | 14 | ||||||
| Share-based compensation | 171 | 226 | ||||||
| Other | 81 | 73 | ||||||
| Net cash provided by operating activities | 2,975 | 4,239 | ||||||
| Cash flows from investing activities: | ||||||||
| Purchase of property and equipment | (1,941 | ) | (1,496 | ) | ||||
| Acquisition of hospitals and health care entities | (116 | ) | (98 | ) | ||||
| Sales of hospitals and health care entities | 20 | 30 | ||||||
| Change in investments | (2 | ) | (12 | ) | ||||
| Other | (11 | ) | 7 | |||||
| Net cash used in investing activities | (2,050 | ) | (1,569 | ) | ||||
| Cash flows from financing activities: | ||||||||
| Issuances of long-term debt | 5,966 | 4,337 | ||||||
| Net change in revolving credit facilities | 930 | 800 | ||||||
| Repayment of long-term debt | (2,690 | ) | (3,731 | ) | ||||
| Distributions to noncontrolling interests | (333 | ) | (357 | ) | ||||
| Payment of debt issuance costs | (53 | ) | (32 | ) | ||||
| Payment of dividends | (337 | ) | (325 | ) | ||||
| Repurchase of common stock | (4,783 | ) | (3,814 | ) | ||||
| Other | (201 | ) | (224 | ) | ||||
| Net cash used in financing activities | (1,501 | ) | (3,346 | ) | ||||
| Effect of exchange rate changes on cash and cash equivalents | (17 | ) | 3 | |||||
| Change in cash and cash equivalents | (593 | ) | (673 | ) | ||||
| Cash and cash equivalents at beginning of period | 1,451 | 1,793 | ||||||
| Cash and cash equivalents at end of period | $ | 858 | $ | 1,120 | ||||
| Interest payments | $ | 777 | $ | 755 | ||||
| Income tax payments, net | $ | 609 | $ | 844 |
HCA Healthcare, Inc.
Operating Statistics
| Second Quarter | For the Six Months Ended June 30, | |||||||||||||||
| 2022 | 2021 | 2022 | 2021 | |||||||||||||
| Operations: | ||||||||||||||||
| Number of Hospitals | 182 | 187 | 182 | 187 | ||||||||||||
| Number of Freestanding Outpatient Surgery Centers* | 126 | 122 | 126 | 122 | ||||||||||||
| Licensed Beds at End of Period | 48,979 | 49,693 | 48,979 | 49,693 | ||||||||||||
| Weighted Average Beds in Service | 41,930 | 42,464 | 41,875 | 42,413 | ||||||||||||
| Reported: | ||||||||||||||||
| Admissions | 515,113 | 532,041 | 1,022,069 | 1,038,421 | ||||||||||||
| % Change | -3.2 | % | -1.6 | % | ||||||||||||
| Equivalent Admissions | 902,757 | 916,212 | 1,762,047 | 1,748,701 | ||||||||||||
| % Change | -1.5 | % | 0.8 | % | ||||||||||||
| Revenue per Equivalent Admission | $ | 16,417 | $ | 15,756 | $ | 16,892 | $ | 16,248 | ||||||||
| % Change | 4.2 | % | 4.0 | % | ||||||||||||
| Inpatient Revenue per Admission | $ | 16,727 | $ | 16,144 | $ | 17,207 | $ | 16,606 | ||||||||
| % Change | 3.6 | % | 3.6 | % | ||||||||||||
| Patient Days | 2,571,328 | 2,629,950 | 5,253,046 | 5,300,991 | ||||||||||||
| % Change | -2.2 | % | -0.9 | % | ||||||||||||
| Equivalent Patient Days | 4,510,739 | 4,535,678 | 9,056,251 | 8,926,869 | ||||||||||||
| % Change | -0.5 | % | 1.4 | % | ||||||||||||
| Inpatient Surgery Cases | 130,961 | 136,460 | 257,841 | 264,050 | ||||||||||||
| % Change | -4.0 | % | -2.4 | % | ||||||||||||
| Outpatient Surgery Cases | 258,182 | 262,107 | 505,603 | 493,335 | ||||||||||||
| % Change | -1.5 | % | 2.5 | % | ||||||||||||
| Emergency Room Visits | 2,223,999 | 2,128,428 | 4,280,388 | 3,970,206 | ||||||||||||
| % Change | 4.5 | % | 7.8 | % | ||||||||||||
| Outpatient Revenues as a | ||||||||||||||||
| Percentage of Patient Revenues | 38.9 | % | 38.2 | % | 38.1 | % | 37.0 | % | ||||||||
| Average Length of Stay (days) | 4.992 | 4.943 | 5.140 | 5.105 | ||||||||||||
| Occupancy (weighted average beds in service) | 67.4 | % | 68.1 | % | 69.3 | % | 69.1 | % | ||||||||
| Same Facility: | ||||||||||||||||
| Admissions | 511,132 | 517,114 | 1,014,200 | 1,010,054 | ||||||||||||
| % Change | -1.2 | % | 0.4 | % | ||||||||||||
| Equivalent Admissions | 892,948 | 888,402 | 1,742,396 | 1,695,881 | ||||||||||||
| % Change | 0.5 | % | 2.7 | % | ||||||||||||
| Revenue per Equivalent Admission | $ | 16,385 | $ | 15,838 | $ | 16,865 | $ | 16,365 | ||||||||
| % Change | 3.5 | % | 3.1 | % | ||||||||||||
| Inpatient Revenue per Admission | $ | 16,771 | $ | 16,236 | $ | 17,243 | $ | 16,693 | ||||||||
| % Change | 3.3 | % | 3.3 | % | ||||||||||||
| Inpatient Surgery Cases | 130,036 | 133,164 | 256,006 | 258,188 | ||||||||||||
| % Change | -2.3 | % | -0.8 | % | ||||||||||||
| Outpatient Surgery Cases | 250,420 | 253,982 | 490,644 | 478,887 | ||||||||||||
| % Change | -1.4 | % | 2.5 | % | ||||||||||||
| Emergency Room Visits | 2,199,787 | 2,049,483 | 4,234,479 | 3,825,367 | ||||||||||||
| % Change | 7.3 | % | 10.7 | % |
HCA Healthcare, Inc.
Supplemental Non-GAAP Disclosures
Operating Results Summary
(Dollars in millions, except per share amounts)
| Second Quarter | For the Six Months Ended June 30, | |||||||||||||||
| 2022 | 2021 | 2022 | 2021 | |||||||||||||
| Revenues | $ | 14,820 | $ | 14,435 | $ | 29,765 | $ | 28,412 | ||||||||
| Net income attributable to HCA Healthcare, Inc. | $ | 1,155 | $ | 1,450 | $ | 2,428 | $ | 2,873 | ||||||||
| Losses (gains) on sales of facilities (net of tax) | 32 | (6 | ) | 24 | (7 | ) | ||||||||||
| Losses on retirement of debt (net of tax) | 60 | 9 | 60 | 9 | ||||||||||||
| Net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt (a) | 1,247 | 1,453 | 2,512 | 2,875 | ||||||||||||
| Depreciation and amortization | 738 | 712 | 1,470 | 1,409 | ||||||||||||
| Interest expense | 434 | 386 | 842 | 770 | ||||||||||||
| Provision for income taxes | 399 | 454 | 746 | 846 | ||||||||||||
| Net income attributable to noncontrolling interests | 224 | 214 | 416 | 371 | ||||||||||||
| Adjusted EBITDA (a) | $ | 3,042 | $ | 3,219 | $ | 5,986 | $ | 6,271 | ||||||||
| Adjusted EBITDA margin (a) | 20.5 | % | 22.3 | % | 20.1 | % | 22.1 | % | ||||||||
| Diluted earnings per share: | ||||||||||||||||
| Net income attributable to HCA Healthcare, Inc. | $ | 3.90 | $ | 4.36 | $ | 8.05 | $ | 8.50 | ||||||||
| Losses (gains) on sales of facilities | 0.11 | (0.02 | ) | 0.08 | (0.02 | ) | ||||||||||
| Losses on retirement of debt | 0.20 | 0.03 | 0.20 | 0.03 | ||||||||||||
| Net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt (a) | $ | 4.21 | $ | 4.37 | $ | 8.33 | $ | 8.51 | ||||||||
| Shares used in computing diluted earnings per share (millions) | 296.061 | 332.613 | 301.690 | 337.940 |
Management and investors review both the overall performance (including net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and GAAP net income attributable to HCA Healthcare, Inc.) and operating performance (Adjusted EBITDA) of our health care facilities. Adjusted EBITDA and the Adjusted EBITDA margin (Adjusted EBITDA divided by revenues) are utilized by management and investors to compare our current operating results with the corresponding periods during the previous year and to compare our operating results with other companies in the health care industry. It is reasonable to expect that losses (gains) on sales of facilities and losses on retirement of debt will occur in future periods, but the amounts recognized can vary significantly from period to period, do not directly relate to the ongoing operations of our health care facilities and complicate period comparisons of our results of operations and operations comparisons with other health care companies.
Net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA are not measures of financial performance under GAAP, and should not be considered as alternatives to net income attributable to HCA Healthcare, Inc. as a measure of operating performance or cash flows from operating, investing and financing activities as a measure of liquidity. Because net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA are not measurements determined in accordance with GAAP and are susceptible to varying calculations, net income attributable to HCA Healthcare, Inc., excluding losses (gains) on sales of facilities and losses on retirement of debt, and Adjusted EBITDA, as presented, may not be comparable to other similarly titled measures presented by other companies.