Tenet Healthcare (NYSE:THC) reported 2025 net operating revenues of $21.3 billion and consolidated Adjusted EBITDA of $4.57 billion, up 14% from 2024, as the company cited strong same-store revenue growth, high patient acuity, and disciplined cost controls. Full-year Adjusted EBITDA margin was 21.4%, improving more than 200 basis points year over year, according to management’s prepared remarks on the company’s fourth-quarter 2025 earnings call.
For the fourth quarter, Tenet generated net operating revenues of $5.5 billion and consolidated Adjusted EBITDA of $1.183 billion, a 13% increase from the prior year. Fourth-quarter Adjusted EBITDA margin was also 21.4%, CFO Sun Park said.
USPI and hospitals both post double-digit annual EBITDA growth
In the fourth quarter, USPI Adjusted EBITDA grew 9% year over year and segment margin was 40.5%. Park said USPI posted a 7.2% increase in same-facility system-wide revenues, driven by 5.5% net revenue per case growth and 1.6% same-facility case volume growth.
Tenet’s hospital segment produced Adjusted EBITDA of $2.54 billion for 2025, up 16%. Sutaria said same-store revenue per adjusted admission rose 5.3% for the year as payer mix and acuity remained strong. In the fourth quarter, hospital Adjusted EBITDA was $603 million, also up 16% from the year-ago period. Same-hospital inpatient adjusted admissions were flat, while revenue per adjusted admission grew 7.5% year over year.
When asked about hospital same-store volume softness in the quarter, Sutaria said respiratory season was “probably a little weaker than otherwise might have expected,” while emphasizing that acuity remained good.
Capital deployment: acquisitions, de novos, and buybacks
Management said Tenet invested nearly $350 million in USPI M&A and de novo activity during 2025, adding 35 facilities, and described the pipeline as strong entering 2026. Park said the company is targeting $250 million of USPI M&A in 2026.
Tenet also emphasized shareholder returns through repurchases. Sutaria said the company has retired about 22% of outstanding shares since initiating its repurchase program in the fourth quarter of 2022, spending roughly $2.5 billion. Park added that Tenet repurchased 943,000 shares for $198 million in the fourth quarter and 8.8 million shares for $1.386 billion during 2025.
Cash flow, leverage, and balance sheet update
Tenet generated $367 million of free cash flow in the fourth quarter and $2.53 billion for full-year 2025. As of Dec. 31, 2025, the company had $2.8 billion of cash on hand, no borrowings under its line of credit, and no significant debt maturities until late 2027, Park said.
Leverage ended the year at 2.25x EBITDA (2.85x EBITDA less non-controlling interest), which Park attributed to operational performance and financial discipline.
2026 outlook reflects exchange headwinds and cost initiatives
Tenet guided to 2026 consolidated net operating revenues of $21.5 billion to $22.3 billion and Adjusted EBITDA of $4.485 billion to $4.785 billion. The company projected USPI Adjusted EBITDA of $2.13 billion to $2.23 billion and hospital Adjusted EBITDA of $2.355 billion to $2.555 billion.
A key variable in the 2026 outlook is the expected impact from the expiration of enhanced premium tax credits on the ACA exchange marketplace. Sutaria said Tenet assumed a 20% reduction in overall exchange enrollment given exposure in states including Arizona, Michigan, and California, and described uncertainty around effectuation rates and the potential for higher uninsured levels.
Park estimated the expiration would create a $250 million headwind to 2026 Adjusted EBITDA, primarily in the hospital segment, and said Tenet plans to use Conifer’s capabilities to help patients with insurance coverage.
Management also pointed to additional items affecting year-over-year comparisons. Park noted Tenet recognized $148 million of prior-year supplemental Medicaid payments in 2025, and expects a one-time $40 million favorable revenue adjustment in the first quarter of 2026 related to the completed Conifer transaction.
On supplemental Medicaid payments, Sutaria said Tenet finished 2025 with $1.34 billion in total supplemental payments, including $148 million in out-of-period payments; guidance assumes a “pretty consistent” level versus the normalized 2025 baseline. He also said the company is not including incremental contributions from supplemental Medicaid programs that have not been approved.
Operational priorities: technology-driven expense management and ASC tailwinds
In Q&A, Sutaria described a more “structural” approach to expense management, including technology deployment, automation, and work through the company’s Global Business Center. He also pointed to the use of technology to improve clinical throughput, citing areas such as length-of-stay management and operating room and emergency room throughput. Management did not quantify expected savings from these initiatives.
On the ASC business, Sutaria reiterated expectations that the phase-out of the Inpatient Only List beginning in 2026 could be a gradual multi-year tailwind for USPI. He cited opportunities in higher-acuity procedures such as spine and urology, continued buildout of a urology platform, expanded robotics capabilities in ASCs, and ongoing double-digit growth in joint replacement programs. He also noted a pickup in gastrointestinal case recovery in the fourth quarter.
Tenet also provided additional detail on exchange exposure in the fourth quarter, stating exchange admissions were about 7.5% of total admissions and exchange revenue was roughly 6% to 6.5% of consolidated revenues. Management said USPI’s exchange exposure is “significantly less” than the hospital segment and did not observe significant procedure “pull forward” from exchange patients in the fourth quarter.
For 2026, Park said Tenet’s assumptions include same-hospital admission growth of 1% to 2%, adjusted admission growth of 1% to 2%, and same-facility USPI revenue growth of 3% to 6%.
- 2026 cash flow outlook: adjusted cash flow from operations of $3.2 billion to $3.6 billion; capital expenditures of $700 million to $800 million; and adjusted free cash flow of $2.5 billion to $2.8 billion.
- First-quarter cadence: Park said Tenet expects first-quarter 2026 consolidated Adjusted EBITDA to be about 24% of full-year EBITDA at the midpoint, with USPI at about 22%.
On payer contracting, Sutaria said Tenet’s rate commentary was consistent with prior views, pointing to a 3% to 5% range from payers. He added the company is “virtually contracting” in 2026 (high 90s percent) and about 80% contracted for 2027.
About Tenet Healthcare (NYSE:THC)
Tenet Healthcare Corporation (NYSE: THC) is a diversified American healthcare services company that owns and operates acute care hospitals and a broad range of outpatient facilities. Its portfolio includes general acute-care hospitals, specialty hospitals, ambulatory surgery centers, urgent care and diagnostic imaging centers, and other ancillary service locations. Tenet’s operations are oriented around delivering inpatient and outpatient clinical care across multiple medical specialties, with an emphasis on surgical services, emergency care, and advanced diagnostics.
In addition to facility-based care, Tenet provides integrated services designed to support clinical operations and improve patient access and care coordination.
