After Jumping Over COVID-19 Hurdles, Labor Challenges Are Pressuring HCA Shares

Business Strategy & Outlook:

HCA operates the largest network of hospitals in the United States, focusing on attractive geographic locations where it has the potential for leading and increasing market share. While it has locations in nearly 20 states and headquarters in Nashville, its facilities are particularly concentrated in Texas and Florida, which represent over half of its bed count. In those states, urban areas of focus include Dallas, Austin, Tampa, and Miami, and those geographic areas provide a good sense of the positive demographic factors that the firm aims to benefit from across the country.

Within its target markets, HCA aims to expand market share through a variety of strategies to attract patients, physicians, and third-party payers. The company provides wide networks of facilities within its chosen geographic markets with key hospital anchors supported by ambulatory surgical centers, urgent care centers, and physician clinics at convenient access points. HCA aims to be the facility of choice for physicians who are typically free agents with practicing rights to other hospitals in the area. For example, HCA has spent the past decade or so investing in its surgical suites to improve efficiency, nursing, and technology offerings to appeal to surgeons scheduling those procedures and positively influence patient satisfaction, which builds on the reputation of HCA’s facilities. From a payer standpoint, HCA continues to contract with health insurers in three-year cycles, which is typically manageable but is causing some concerns due to spiking labor costs. Overall though, HCA’s strategies have generally yielded positive results over the long run. For example, the company continues to grind out market share gains in its local markets with market share standing at roughly 27% at the end of 2020, up from 23% in 2011, according to HCA management. Once HCA works through current labor challenges, we expect the firm to grow its top line in the midsingle digits and its adjusted earnings per share to grow in the low double digits.

Financial Strengths:

At the end of 2021, the company owed about $35 billion in debt, or gross leverage of less than 3 times, or below its new leverage target of 3.0 to 4.0 times, which is down from 3.5 and 4.5 times previously. At the end of 2021, HCA held just under $2 billion in cash after returning the government aid that it was originally granted during the COVID-19 health crisis of 2020. With those liquid resources at its disposal and free cash flows expected to range between roughly $5 billion and $7 billion annually during the next five years, HCA should be able to manage its debt maturities during the next five years through internal means. Those maturities include $0.2 billion due in 2022, $2.9 billion due in 2023, $2.4 billion due in 2024, $4.6 billion due in 2025, and $5.3 billion in 2026. However, the company plans to return significant cash to stakeholders going forward. As of February 2022, the company was authorized to repurchase about $9 billion in shares, which the firm expects to use in the next couple of years. Also, HCA just reinstated its dividend ($0.6 billion annual run rate), which was temporarily suspended during the the pandemic. The company also distributed about $0.7 billion in cash to noncontrolling interests in 2021, and we would expect those outflows to grow mildly going forward. Overall, we expect HCA’s planned distributions to stakeholders may lead to more debt issuance to refinance maturities or even to finance some of these outflows to stakeholders, going forward.

Bulls Say:

Beyond administrative function efficiency, HCA’s large scale gives it an opportunity to test and expand best practices throughout its network of facilities to improve service quality and efficiency.
HCA’s focus on attractive geographic locations gives it a volume tailwind that should positively affect its top line.
The company’s financial leverage should be easily manageable, giving HCA flexibility for U.S. healthcare policy changes or other shocks to the system that could constrain demand for the more elective, and highly profitable, parts of its business.

Company Description:

HCA Healthcare is a Nashville-based healthcare provider organization operating the largest collection of acute-care hospitals in the U.S. As of December 2021, the firm owned and operated 182 hospitals, 125 freestanding outpatient surgery centers, and a broad network of physician offices, urgent care clinics, and freestanding emergency rooms across nearly 20 states and a small foothold in England

(Source: Morningstar)

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