The largest hospital company in the country won’t overhaul its outpatient facility development strategy should a site-neutral payments system become Medicare policy, its CEO said Jan. 24.
Healthcare stakeholders have staked out opposing positions in recent years in response to several proposals to institute site-neutral payments, which would pay providers the same amount regardless of the care setting. Organizations including the American College of Physicians and the American Academy of Family Physicians (as well as America’s Health Insurance Plans) have backed proposals to equalize payments while the American Hospital Association has been out front in opposing those efforts.
On a conference call discussing Nashville-based HCA’s fourth-quarter results, executives reiterated that they are against payment reforms that would lower hospitals’ reimbursement rates. But CEO Sam Hazen also said that the company’s efforts to grow its health systems anchored by 190 hospitals wouldn’t be affected.
“We are finding opportunities to extend the reach of our networks into new communities […] and then fully integrate that particular facility into the larger hospital-centric health system,” Hazen told analysts. “I don’t see any changes to that as a result of a Medicare site-neutral provision if one were to be implemented.”
HCA has since the end of 2020 added about 400 sites of care to its network, which now numbers 2,400 locations, while it has grown its hospital count by a net of only five facilities. Hazen and his team have made that expansion—comprising hospice care and rehabilitation services as well as surgery and imaging centers, among other things—one of their key growth strategies as: In a late-2023 presentation to investors, they pointed to network expansion as a key driver of HCA’s three-percentage-point gain in inpatient market share over roughly the previous decade.
Network expansion typically accounts for about half of HCA’s capital spending each year. Hazen said that won’t change in 2025, when the company plans to spend about $5.2 billion on maintenance and growth projects—a figure that’s up from $4.9 billion last year and $4.7 billion in 2023.
Among the other forecasts HCA leaders presented along with their fourth-quarter numbers is equivalent admissions growth of 3 percent to 4 percent. That’s down from 4.5 percent in 2024 but still above the historical range by about a percentage point and indicative of the strong rebound in patient activity since the end of the COVID-19 pandemic.
Shares of HCA (Ticker: HCA) fell more than 3 percent to about $313 after executives’ earnings report and conference call. They’ve fallen about 8 percent over the past six months, which has trimmed the company’s market capitalization to about $79 billion.
