Quarterly report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the quarterly period ended September 30, 2021 |
Transition report pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 for the transition period from to |
(State of Incorporation) | (IRS Employer Identification No.) |
Title of each class | Trading symbol | Name of each exchange on which registered | |||||||||||||||
$0.05 par value | |||||||||||||||||
x | Accelerated filer | ¨ | Non-accelerated filer | ¨ | |||||||||||||||||||||||||
Smaller reporting company | Emerging growth company |
Page | |||||||||||
September 30, | December 31, | |||||||||||||
2021 | 2020 | |||||||||||||
ASSETS | ||||||||||||||
Current assets: | ||||||||||||||
Cash and cash equivalents | $ | $ | ||||||||||||
Accounts receivable | ||||||||||||||
Inventories of supplies, at cost | ||||||||||||||
Assets held for sale | ||||||||||||||
Other current assets | ||||||||||||||
Total current assets | ||||||||||||||
Investments and other assets | ||||||||||||||
Deferred income taxes | ||||||||||||||
Property and equipment, at cost, less accumulated depreciation and amortization ($ | ||||||||||||||
Goodwill | ||||||||||||||
Other intangible assets, at cost, less accumulated amortization ($ | ||||||||||||||
Total assets | $ | $ | ||||||||||||
LIABILITIES AND EQUITY | ||||||||||||||
Current liabilities: | ||||||||||||||
Current portion of long-term debt | $ | $ | ||||||||||||
Accounts payable | ||||||||||||||
Accrued compensation and benefits | ||||||||||||||
Professional and general liability reserves | ||||||||||||||
Accrued interest payable | ||||||||||||||
Liabilities held for sale | ||||||||||||||
Contract liabilities | ||||||||||||||
Other current liabilities | ||||||||||||||
Total current liabilities | ||||||||||||||
Long-term debt, net of current portion | ||||||||||||||
Professional and general liability reserves | ||||||||||||||
Defined benefit plan obligations | ||||||||||||||
Deferred income taxes | ||||||||||||||
Contract liabilities – long-term | ||||||||||||||
Other long-term liabilities | ||||||||||||||
Total liabilities | ||||||||||||||
Commitments and contingencies | ||||||||||||||
Redeemable noncontrolling interests in equity of consolidated subsidiaries | ||||||||||||||
Equity: | ||||||||||||||
Shareholders’ equity: | ||||||||||||||
Common stock, $ issued at September 30, 2021 and | ||||||||||||||
Additional paid-in capital | ||||||||||||||
Accumulated other comprehensive loss | ( | ( | ||||||||||||
Accumulated deficit | ( | ( | ||||||||||||
Common stock in treasury, at cost, | ( | ( | ||||||||||||
Total shareholders’ equity | ||||||||||||||
Noncontrolling interests | ||||||||||||||
Total equity | ||||||||||||||
Total liabilities and equity | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Net operating revenues | $ | $ | $ | $ | ||||||||||||||||||||||
Grant income | ( | |||||||||||||||||||||||||
Equity in earnings of unconsolidated affiliates | ||||||||||||||||||||||||||
Operating expenses: | ||||||||||||||||||||||||||
Salaries, wages and benefits | ||||||||||||||||||||||||||
Supplies | ||||||||||||||||||||||||||
Other operating expenses, net | ||||||||||||||||||||||||||
Depreciation and amortization | ||||||||||||||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | ||||||||||||||||||||||||||
Litigation and investigation costs | ||||||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | ( | ( | ( | ( | ||||||||||||||||||||||
Operating income | ||||||||||||||||||||||||||
Interest expense | ( | ( | ( | ( | ||||||||||||||||||||||
Other non-operating income, net | ||||||||||||||||||||||||||
Loss from early extinguishment of debt | ( | ( | ( | ( | ||||||||||||||||||||||
Income (loss) from continuing operations, before income taxes | ( | ( | ||||||||||||||||||||||||
Income tax benefit (expense) | ( | ( | ||||||||||||||||||||||||
Income (loss) from continuing operations, before discontinued operations | ( | |||||||||||||||||||||||||
Discontinued operations: | ||||||||||||||||||||||||||
Income from operations | ||||||||||||||||||||||||||
Income from discontinued operations | ||||||||||||||||||||||||||
Net income (loss) | ( | |||||||||||||||||||||||||
Less: Net income available to noncontrolling interests | ||||||||||||||||||||||||||
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders | $ | $ | ( | $ | $ | ( | ||||||||||||||||||||
Amounts available (attributable) to Tenet Healthcare Corporation common shareholders | ||||||||||||||||||||||||||
Income (loss) from continuing operations, net of tax | $ | $ | ( | $ | $ | ( | ||||||||||||||||||||
Income from discontinued operations, net of tax | ||||||||||||||||||||||||||
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders | $ | $ | ( | $ | $ | ( | ||||||||||||||||||||
Earnings (loss) per share available (attributable) to Tenet Healthcare Corporation common shareholders: | ||||||||||||||||||||||||||
Basic | ||||||||||||||||||||||||||
Continuing operations | $ | $ | ( | $ | $ | ( | ||||||||||||||||||||
Discontinued operations | ||||||||||||||||||||||||||
$ | $ | ( | $ | $ | ( | |||||||||||||||||||||
Diluted | ||||||||||||||||||||||||||
Continuing operations | $ | $ | ( | $ | $ | ( | ||||||||||||||||||||
Discontinued operations | ||||||||||||||||||||||||||
$ | $ | ( | $ | $ | ( | |||||||||||||||||||||
Weighted average shares and dilutive securities outstanding (in thousands): | ||||||||||||||||||||||||||
Basic | ||||||||||||||||||||||||||
Diluted |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Net income (loss) | $ | $ | ( | $ | $ | |||||||||||||||||||||
Other comprehensive income: | ||||||||||||||||||||||||||
Amortization of net actuarial loss included in other non-operating income, net | ||||||||||||||||||||||||||
Unrealized gains on debt securities held as available-for-sale | ||||||||||||||||||||||||||
Foreign currency translation adjustments | ||||||||||||||||||||||||||
Other comprehensive income before income taxes | ||||||||||||||||||||||||||
Income tax benefit (expense) related to items of other comprehensive income | ( | ( | ||||||||||||||||||||||||
Total other comprehensive income, net of tax | ||||||||||||||||||||||||||
Comprehensive net income (loss) | ( | |||||||||||||||||||||||||
Less: Comprehensive income available to noncontrolling interests | ||||||||||||||||||||||||||
Comprehensive income available (loss attributable) to Tenet Healthcare Corporation common shareholders | $ | $ | ( | $ | $ | ( |
Nine Months Ended September 30, | ||||||||||||||
2021 | 2020 | |||||||||||||
Net income | $ | $ | ||||||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||||||||
Depreciation and amortization | ||||||||||||||
Deferred income tax expense (benefit) | ( | |||||||||||||
Stock-based compensation expense | ||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | ||||||||||||||
Litigation and investigation costs | ||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | ( | ( | ||||||||||||
Loss from early extinguishment of debt | ||||||||||||||
Equity in earnings of unconsolidated affiliates, net of distributions received | ( | |||||||||||||
Amortization of debt discount and debt issuance costs | ||||||||||||||
Other items, net | ( | ( | ||||||||||||
Changes in cash from operating assets and liabilities: | ||||||||||||||
Accounts receivable | ( | |||||||||||||
Inventories and other current assets | ( | |||||||||||||
Income taxes | ||||||||||||||
Accounts payable, accrued expenses, contract liabilities and other current liabilities | ( | |||||||||||||
Other long-term liabilities | ||||||||||||||
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements | ( | ( | ||||||||||||
Net cash used in operating activities from discontinued operations, excluding income taxes | ( | ( | ||||||||||||
Net cash provided by operating activities | ||||||||||||||
Cash flows from investing activities: | ||||||||||||||
Purchases of property and equipment | ( | ( | ||||||||||||
Purchases of businesses or joint venture interests, net of cash acquired | ( | ( | ||||||||||||
Proceeds from sales of facilities and other assets | ||||||||||||||
Proceeds from sales of marketable securities, long-term investments and other assets | ||||||||||||||
Purchases of marketable securities and equity investments | ( | ( | ||||||||||||
Other items, net | ( | |||||||||||||
Net cash provided by (used in) investing activities | ( | |||||||||||||
Cash flows from financing activities: | ||||||||||||||
Repayments of borrowings under credit facility | ( | |||||||||||||
Proceeds from borrowings under credit facility | ||||||||||||||
Repayments of other borrowings | ( | ( | ||||||||||||
Proceeds from other borrowings | ||||||||||||||
Debt issuance costs | ( | ( | ||||||||||||
Distributions paid to noncontrolling interests | ( | ( | ||||||||||||
Proceeds from sale of noncontrolling interests | ||||||||||||||
Purchases of noncontrolling interests | ( | ( | ||||||||||||
Proceeds from shares issued under stock-based compensation plans, net of taxes paid related to net share settlement | ||||||||||||||
Medicare advances and grants received by unconsolidated affiliates, net of recoupment | ( | |||||||||||||
Other items, net | ( | |||||||||||||
Net cash provided by (used in) financing activities | ( | |||||||||||||
Net increase (decrease) in cash and cash equivalents | ( | |||||||||||||
Cash and cash equivalents at beginning of period | ||||||||||||||
Cash and cash equivalents at end of period | $ | $ | ||||||||||||
Supplemental disclosures: | ||||||||||||||
Interest paid, net of capitalized interest | $ | ( | $ | ( | ||||||||||
Income tax payments, net | $ | ( | $ | ( |
Gross Carrying Amount | Accumulated Amortization | Net Book Value | ||||||||||||||||||
At September 30, 2021: | ||||||||||||||||||||
Capitalized software costs | $ | $ | ( | $ | ||||||||||||||||
Trade names | ||||||||||||||||||||
Contracts | ( | |||||||||||||||||||
Other | ( | |||||||||||||||||||
Total | $ | $ | ( | $ |
Gross Carrying Amount | Accumulated Amortization | Net Book Value | ||||||||||||||||||
At December 31, 2020: | ||||||||||||||||||||
Capitalized software costs | $ | $ | ( | $ | ||||||||||||||||
Trade names | ||||||||||||||||||||
Contracts | ( | |||||||||||||||||||
Other | ( | |||||||||||||||||||
Total | $ | $ | ( | $ |
Three Months Ending | Years Ending | Later Years | ||||||||||||||||||||||||||||||||||||||||||
December 31, | ||||||||||||||||||||||||||||||||||||||||||||
Total | 2021 | 2022 | 2023 | 2024 | 2025 | |||||||||||||||||||||||||||||||||||||||
Amortization of intangible assets | $ | $ | $ | $ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Net operating revenues | $ | $ | $ | $ | ||||||||||||||||||||||
Net income | $ | $ | $ | $ | ||||||||||||||||||||||
Net income available to the investees | $ | $ | $ | $ |
September 30, 2021 | December 31, 2020 | |||||||||||||
Continuing operations: | ||||||||||||||
Patient accounts receivable | $ | $ | ||||||||||||
Estimated future recoveries | ||||||||||||||
Net cost reports and settlements receivable and valuation allowances | ||||||||||||||
Discontinued operations | ||||||||||||||
Accounts receivable, net | $ | $ |
September 30, 2021 | December 31, 2020 | ||||||||||
Assets: | |||||||||||
Other current assets | $ | $ | |||||||||
Investments and other assets | $ | $ | |||||||||
Liabilities: | |||||||||||
Other current liabilities | $ | $ | |||||||||
Other long-term liabilities | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Estimated costs for: | ||||||||||||||||||||||||||
Uninsured patients | $ | $ | $ | $ | ||||||||||||||||||||||
Charity care patients | ||||||||||||||||||||||||||
Total | $ | $ | $ | $ | ||||||||||||||||||||||
Contract Liability – | Contract Liability – | |||||||||||||||||||
Current | Long-term | |||||||||||||||||||
Contract Assets | Advances from Medicare | Advances from Medicare | ||||||||||||||||||
December 31, 2020 | $ | $ | $ | |||||||||||||||||
September 30, 2021 | ||||||||||||||||||||
Increase (decrease) | $ | ( | $ | $ | ( |
December 31, 2019 | $ | $ | $ | |||||||||||||||||
September 30, 2020 | ||||||||||||||||||||
Increase | $ | $ | $ |
Contract Liability – | Contract Liability – | |||||||||||||
Current | Long-term | |||||||||||||
Advances from Medicare | Advances from Medicare | |||||||||||||
December 31, 2020 | $ | $ | ||||||||||||
September 30, 2021 | ||||||||||||||
Increase (decrease) | $ | $ | ( | |||||||||||
December 31, 2019 | $ | $ | ||||||||||||
September 30, 2020 | ||||||||||||||
Increase | $ | $ |
Contract Liability – | Contract Liability – | |||||||||||||||||||||||||
Contract Asset – | Current | Long-Term | ||||||||||||||||||||||||
Receivables | Unbilled Revenue | Deferred Revenue | Deferred Revenue | |||||||||||||||||||||||
December 31, 2020 | $ | $ | $ | $ | ||||||||||||||||||||||
September 30, 2021 | ||||||||||||||||||||||||||
Increase (decrease) | $ | ( | $ | ( | $ | $ | ( | |||||||||||||||||||
December 31, 2019 | $ | $ | $ | $ | ||||||||||||||||||||||
September 30, 2020 | ||||||||||||||||||||||||||
Increase (decrease) | $ | $ | $ | ( | $ | ( |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Significant disposals: | ||||||||||||||||||||||||||
Income from continuing operations, before income taxes | ||||||||||||||||||||||||||
Miami area | $ | $ | $ | $ | ||||||||||||||||||||||
Total | $ | $ | $ | $ |
September 30, 2021 | December 31, 2020 | |||||||||||||
Senior unsecured notes: | ||||||||||||||
$ | $ | |||||||||||||
Senior secured first lien notes: | ||||||||||||||
Senior secured second lien notes: | ||||||||||||||
Finance leases, mortgage and other notes | ||||||||||||||
Unamortized issue costs and note discounts | ( | ( | ||||||||||||
Total long-term debt | ||||||||||||||
Less current portion | ||||||||||||||
Long-term debt, net of current portion | $ | $ |
Number of Options | Weighted Average Exercise Price Per Share | Aggregate Intrinsic Value | Weighted Average Remaining Life | |||||||||||||||||||||||
Outstanding at December 31, 2020 | $ | |||||||||||||||||||||||||
Exercised | ( | $ | ||||||||||||||||||||||||
Outstanding at September 30, 2021 | $ | $ | ||||||||||||||||||||||||
Vested and expected to vest at September 30, 2021 | $ | $ | ||||||||||||||||||||||||
Exercisable at September 30, 2021 | $ | $ |
Options Outstanding | Options Exercisable | |||||||||||||||||||||||||||||||
Range of Exercise Prices | Number of Options | Weighted Average Remaining Contractual Life | Weighted Average Exercise Price Per Share | Number of Options | Weighted Average Exercise Price Per Share | |||||||||||||||||||||||||||
$ | $ | $ | ||||||||||||||||||||||||||||||
$ | $ | $ | ||||||||||||||||||||||||||||||
$ | $ |
Number of Restricted Stock Units | Weighted Average Grant Date Fair Value Per Unit | |||||||||||||
Unvested at December 31, 2020 | $ | |||||||||||||
Granted | $ | |||||||||||||
Vested | ( | $ | ||||||||||||
Forfeited | ( | $ | ||||||||||||
Unvested at September 30, 2021 | $ |
Nine Months Ended September 30, | ||||||||||||||
2021 | 2020 | |||||||||||||
Expected volatility | % | |||||||||||||
Risk-free interest rate | % |
Number of Restricted Stock Units | Weighted Average Grant Date Fair Value Per Unit | |||||||||||||
Unvested at December 31, 2020 | $ | |||||||||||||
Granted | $ | |||||||||||||
Vested | ( | $ | ||||||||||||
Forfeited | ( | $ | ||||||||||||
Unvested at September 30, 2021 | $ |
Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Loss | Accumulated Deficit | Treasury Stock | Noncontrolling Interests | Total Equity | ||||||||||||||||||||||||||||||||||||||||||||
Shares Outstanding | Issued Par Amount | |||||||||||||||||||||||||||||||||||||||||||||||||
Balances at December 31, 2020 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive loss | — | — | — | ( | — | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Accretion of redeemable noncontrolling interests | — | — | ( | — | — | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Purchases (sales) of businesses and noncontrolling interests, net | — | — | ( | — | — | — | ( | |||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation expense and issuance of common stock | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||
Balances at March 31, 2021 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive income | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||
Accretion of redeemable noncontrolling interests | — | — | ( | — | — | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Purchases of businesses and noncontrolling interests, net | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation expense and issuance of common stock | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||
Balances at June 30, 2021 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive income | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||
Accretion of redeemable noncontrolling interests | — | — | ( | — | — | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Purchases of businesses and noncontrolling interests, net | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation expense and issuance of common stock | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||
Balances at September 30, 2021 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ |
Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Loss | Accumulated Deficit | Treasury Stock | Noncontrolling Interests | Total Equity | ||||||||||||||||||||||||||||||||||||||||||||
Shares Outstanding | Issued Par Amount | |||||||||||||||||||||||||||||||||||||||||||||||||
Balances at December 31, 2019 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive income | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||
Accretion of redeemable noncontrolling interests | — | — | ( | — | — | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Purchases (sales) of businesses and noncontrolling interests, net | — | — | ( | — | — | — | ( | |||||||||||||||||||||||||||||||||||||||||||
Cumulative effect of accounting change | — | — | — | — | ( | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation expense and issuance of common stock | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Balances at March 31, 2020 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||||||||||||
Net income | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive income | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||
Accretion of redeemable noncontrolling interests | — | — | ( | — | — | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Purchases (sales) of businesses and noncontrolling interests, net | — | — | ( | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation expense and issuance of common stock | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Balances at June 30, 2020 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||||||||||||
Net income (loss) | — | — | — | — | ( | — | ( | |||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive income | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||
Accretion of redeemable noncontrolling interests | — | — | ( | — | — | — | — | ( | ||||||||||||||||||||||||||||||||||||||||||
Purchases of businesses and noncontrolling interests, net | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation expense and issuance of common stock | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||
Balances at September 30, 2020 | $ | $ | $ | ( | $ | ( | $ | ( | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Hospital Operations: | ||||||||||||||||||||||||||
Net patient service revenues from hospitals and related outpatient facilities: | ||||||||||||||||||||||||||
Medicare | $ | $ | $ | $ | ||||||||||||||||||||||
Medicaid | ||||||||||||||||||||||||||
Managed care | ||||||||||||||||||||||||||
Uninsured | ||||||||||||||||||||||||||
Indemnity and other | ||||||||||||||||||||||||||
Total | ||||||||||||||||||||||||||
Other revenues(1) | ||||||||||||||||||||||||||
Hospital Operations total prior to inter-segment eliminations | ||||||||||||||||||||||||||
Ambulatory Care | ||||||||||||||||||||||||||
Conifer | ||||||||||||||||||||||||||
Inter-segment eliminations | ( | ( | ( | ( | ||||||||||||||||||||||
Net operating revenues | $ | $ | $ | $ |
(1) | Primarily physician practices revenues. |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Net patient service revenues | $ | $ | $ | $ | ||||||||||||||||||||||
Management fees | ||||||||||||||||||||||||||
Revenue from other sources | ||||||||||||||||||||||||||
Net operating revenues | $ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Revenue cycle services – Tenet | $ | $ | $ | $ | ||||||||||||||||||||||
Revenue cycle services – other customers | ||||||||||||||||||||||||||
Other services – Tenet | ||||||||||||||||||||||||||
Other services – other customers | ||||||||||||||||||||||||||
Net operating revenues | $ | $ | $ | $ |
Three Months Ending | Years Ending | Later Years | ||||||||||||||||||||||||||||||||||||||||||
December 31, | ||||||||||||||||||||||||||||||||||||||||||||
Total | 2021 | 2022 | 2023 | 2024 | 2025 | |||||||||||||||||||||||||||||||||||||||
Performance obligations | $ | $ | $ | $ | $ | $ | $ |
Balances at Beginning of Period | Litigation and Investigation Costs | Cash Payments | Other | Balances at End of Period | ||||||||||||||||||||||||||||
Nine Months Ended September 30, 2021 | $ | $ | $ | ( | $ | ( | $ | |||||||||||||||||||||||||
Nine Months Ended September 30, 2020 | $ | $ | $ | ( | $ | $ |
Nine Months Ended September 30, | ||||||||||||||
2021 | 2020 | |||||||||||||
Balances at beginning of period | $ | $ | ||||||||||||
Net income | ||||||||||||||
Distributions paid to noncontrolling interests | ( | ( | ||||||||||||
Accretion of redeemable noncontrolling interests | ||||||||||||||
Purchases (sales) of businesses and noncontrolling interests, net | ( | |||||||||||||
Balances at end of period | $ | $ |
September 30, 2021 | December 31, 2020 | |||||||||||||
Hospital Operations | $ | $ | ||||||||||||
Ambulatory Care | ||||||||||||||
Conifer | ||||||||||||||
Redeemable noncontrolling interests | $ | $ |
Nine Months Ended September 30, | ||||||||||||||
2021 | 2020 | |||||||||||||
Hospital Operations | $ | $ | ( | |||||||||||
Ambulatory Care | ||||||||||||||
Conifer | ||||||||||||||
Net income available to redeemable noncontrolling interests | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Tax expense (benefit) at statutory federal rate of 21% | $ | $ | ( | $ | $ | ( | ||||||||||||||||||||
State income taxes, net of federal income tax benefit | ( | |||||||||||||||||||||||||
Tax benefit attributable to noncontrolling interests | ( | ( | ( | ( | ||||||||||||||||||||||
Nondeductible goodwill | ||||||||||||||||||||||||||
Nontaxable gains | ||||||||||||||||||||||||||
Stock-based compensation | ( | ( | ||||||||||||||||||||||||
Change in valuation allowance | ( | ( | ||||||||||||||||||||||||
Other items | ||||||||||||||||||||||||||
Income tax expense (benefit) | $ | $ | ( | $ | $ | ( |
Net Income Available (Loss Attributable) to Common Shareholders (Numerator) | Weighted Average Shares (Denominator) | Per-Share Amount | ||||||||||||||||||
Three Months Ended September 30, 2021 | ||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share | $ | $ | ||||||||||||||||||
Effect of dilutive stock options, restricted stock units and deferred compensation units | — | ( | ||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share | $ | $ | ||||||||||||||||||
Three Months Ended September 30, 2020 | ||||||||||||||||||||
Net loss attributable to Tenet Healthcare Corporation common shareholders for basic loss per share | $ | ( | $ | ( | ||||||||||||||||
Effect of dilutive stock options, restricted stock units and deferred compensation units | — | |||||||||||||||||||
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share | $ | ( | $ | ( | ||||||||||||||||
Net Income Available (Loss Attributable) to Common Shareholders (Numerator) | Weighted Average Shares (Denominator) | Per-Share Amount | ||||||||||||||||||
Nine Months Ended September 30, 2021 | ||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders for basic earnings per share | $ | $ | ||||||||||||||||||
Effect of dilutive stock options, restricted stock units and deferred compensation units | — | ( | ||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders for diluted earnings per share | $ | $ | ||||||||||||||||||
Nine Months Ended September 30, 2020 | ||||||||||||||||||||
Net loss attributable to Tenet Healthcare Corporation common shareholders for basic loss per share | $ | ( | $ | ( | ||||||||||||||||
Effect of dilutive stock options, restricted stock units and deferred compensation units | — | |||||||||||||||||||
Net loss attributable to Tenet Healthcare Corporation common shareholders for diluted loss per share | $ | ( | $ | ( |
Total | Quoted Prices in Active Markets for Identical Assets (Level 1) | Significant Other Observable Inputs (Level 2) | Significant Unobservable Inputs (Level 3) | |||||||||||||||||||||||
At December 31, 2020: | ||||||||||||||||||||||||||
Long-lived assets held for sale | $ | $ | $ | $ | ||||||||||||||||||||||
Long-lived assets held and used | ||||||||||||||||||||||||||
$ | $ | $ | $ |
Nine Months Ended September 30, | ||||||||||||||
2021 | 2020 | |||||||||||||
Current assets | $ | $ | ||||||||||||
Property and equipment | ||||||||||||||
Other intangible assets | ||||||||||||||
Goodwill | ||||||||||||||
Other long-term assets, including previously held equity method investments | ||||||||||||||
Current liabilities | ( | ( | ||||||||||||
Long-term liabilities | ( | ( | ||||||||||||
Redeemable noncontrolling interests in equity of consolidated subsidiaries | ( | ( | ||||||||||||
Noncontrolling interests | ( | ( | ||||||||||||
Cash paid, net of cash acquired | ( | ( | ||||||||||||
Gains on consolidations | $ | $ |
September 30, 2021 | December 31, 2020 | |||||||||||||
Assets: | ||||||||||||||
Hospital Operations | $ | $ | ||||||||||||
Ambulatory Care | ||||||||||||||
Conifer | ||||||||||||||
Total | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Capital expenditures: | ||||||||||||||||||||||||||
Hospital Operations | $ | $ | $ | $ | ||||||||||||||||||||||
Ambulatory Care | ||||||||||||||||||||||||||
Conifer | ||||||||||||||||||||||||||
Total | $ | $ | $ | $ | ||||||||||||||||||||||
Net operating revenues: | ||||||||||||||||||||||||||
Hospital Operations total prior to inter-segment eliminations | $ | $ | $ | $ | ||||||||||||||||||||||
Ambulatory Care | ||||||||||||||||||||||||||
Conifer | ||||||||||||||||||||||||||
Tenet | ||||||||||||||||||||||||||
Other clients | ||||||||||||||||||||||||||
Total Conifer revenues | ||||||||||||||||||||||||||
Inter-segment eliminations | ( | ( | ( | ( | ||||||||||||||||||||||
Total | $ | $ | $ | $ | ||||||||||||||||||||||
Equity in earnings of unconsolidated affiliates: | ||||||||||||||||||||||||||
Hospital Operations | $ | $ | $ | $ | ||||||||||||||||||||||
Ambulatory Care | ||||||||||||||||||||||||||
Total | $ | $ | $ | $ | ||||||||||||||||||||||
Adjusted EBITDA: | ||||||||||||||||||||||||||
Hospital Operations | $ | $ | $ | $ | ||||||||||||||||||||||
Ambulatory Care | ||||||||||||||||||||||||||
Conifer | ||||||||||||||||||||||||||
Total | $ | $ | $ | $ | ||||||||||||||||||||||
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Depreciation and amortization: | ||||||||||||||||||||||||||
Hospital Operations | $ | $ | $ | $ | ||||||||||||||||||||||
Ambulatory Care | ||||||||||||||||||||||||||
Conifer | ||||||||||||||||||||||||||
Total | $ | $ | $ | $ | ||||||||||||||||||||||
Adjusted EBITDA | $ | $ | $ | $ | ||||||||||||||||||||||
Depreciation and amortization | ( | ( | ( | ( | ||||||||||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | ( | ( | ( | ( | ||||||||||||||||||||||
Litigation and investigation costs | ( | ( | ( | ( | ||||||||||||||||||||||
Interest expense | ( | ( | ( | ( | ||||||||||||||||||||||
Loss from early extinguishment of debt | ( | ( | ( | ( | ||||||||||||||||||||||
Other non-operating income, net | ||||||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | ||||||||||||||||||||||||||
Income (loss) from continuing operations, before income taxes | $ | $ | ( | $ | $ | ( |
Continuing Operations Three Months Ended September 30, | Increase (Decrease) | ||||||||||||||||||||||
Selected Operating Statistics | 2021 | 2020 | |||||||||||||||||||||
Hospital Operations – hospitals and related outpatient facilities: | |||||||||||||||||||||||
Number of hospitals (at end of period) | 60 | 65 | (5) | (1) | |||||||||||||||||||
Total admissions | 145,412 | 150,690 | (3.5) | % | |||||||||||||||||||
Adjusted patient admissions(2) | 256,250 | 257,704 | (0.6) | % | |||||||||||||||||||
Paying admissions (excludes charity and uninsured) | 136,932 | 141,300 | (3.1) | % | |||||||||||||||||||
Charity and uninsured admissions | 8,480 | 9,390 | (9.7) | % | |||||||||||||||||||
Admissions through emergency department | 110,675 | 112,131 | (1.3) | % | |||||||||||||||||||
Emergency department visits, outpatient | 578,734 | 463,836 | 24.8 | % | |||||||||||||||||||
Total emergency department visits | 689,409 | 575,967 | 19.7 | % | |||||||||||||||||||
Total surgeries | 91,707 | 94,128 | (2.6) | % | |||||||||||||||||||
Patient days — total | 770,175 | 784,013 | (1.8) | % | |||||||||||||||||||
Adjusted patient days(2) | 1,335,610 | 1,302,605 | 2.5 | % | |||||||||||||||||||
Average length of stay (days) | 5.30 | 5.20 | 1.9 | % | |||||||||||||||||||
Average licensed beds | 15,987 | 17,242 | (7.3) | % | |||||||||||||||||||
Utilization of licensed beds(3) | 52.4 | % | 49.4 | % | 3.0 | % | (1) | ||||||||||||||||
Total visits | 1,523,726 | 1,402,346 | 8.7 | % | |||||||||||||||||||
Paying visits (excludes charity and uninsured) | 1,423,068 | 1,302,529 | 9.3 | % | |||||||||||||||||||
Charity and uninsured visits | 100,658 | 99,817 | 0.8 | % | |||||||||||||||||||
Ambulatory Care: | |||||||||||||||||||||||
Total consolidated facilities (at end of period) | 232 | 244 | (12) | (1) | |||||||||||||||||||
Total consolidated cases | 295,026 | 544,279 | (45.8) | % |
(1) | The change is the difference between the 2021 and 2020 amounts shown. | |||||||
(2) | Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues. | |||||||
(3) | Utilization of licensed beds represents patient days divided by number of days in the period divided by average licensed beds. |
Continuing Operations Three Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||
Revenues | 2021 | 2020 | ||||||||||||||||||
Net operating revenues: | ||||||||||||||||||||
Hospital Operations prior to inter-segment eliminations | $ | 4,030 | $ | 3,803 | 6.0 | % | ||||||||||||||
Ambulatory Care | 666 | 565 | 17.9 | % | ||||||||||||||||
Conifer | 314 | 325 | (3.4) | % | ||||||||||||||||
Inter-segment eliminations | (116) | (136) | (14.7) | % | ||||||||||||||||
Total | $ | 4,894 | $ | 4,557 | 7.4 | % |
Continuing Operations Three Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||
Selected Operating Expenses | 2021 | 2020 | ||||||||||||||||||
Hospital Operations: | ||||||||||||||||||||
Salaries, wages and benefits | $ | 1,872 | $ | 1,818 | 3.0 | % | ||||||||||||||
Supplies | 656 | 656 | — | % | ||||||||||||||||
Other operating expenses | 894 | 899 | (0.6) | % | ||||||||||||||||
Total | $ | 3,422 | $ | 3,373 | 1.5 | % | ||||||||||||||
Ambulatory Care: | ||||||||||||||||||||
Salaries, wages and benefits | $ | 169 | $ | 157 | 7.6 | % | ||||||||||||||
Supplies | 170 | 128 | 32.8 | % | ||||||||||||||||
Other operating expenses | 97 | 97 | — | % | ||||||||||||||||
Total | $ | 436 | $ | 382 | 14.1 | % | ||||||||||||||
Conifer: | ||||||||||||||||||||
Salaries, wages and benefits | $ | 168 | $ | 167 | 0.6 | % | ||||||||||||||
Supplies | 1 | — | N/A | |||||||||||||||||
Other operating expenses | 60 | 62 | (3.2) | % | ||||||||||||||||
Total | $ | 229 | $ | 229 | — | % | ||||||||||||||
Total: | ||||||||||||||||||||
Salaries, wages and benefits | $ | 2,209 | $ | 2,142 | 3.1 | % | ||||||||||||||
Supplies | 827 | 784 | 5.5 | % | ||||||||||||||||
Other operating expenses | 1,051 | 1,058 | (0.7) | % | ||||||||||||||||
Total | $ | 4,087 | $ | 3,984 | 2.6 | % | ||||||||||||||
Rent/lease expense(1): | ||||||||||||||||||||
Hospital Operations | $ | 73 | $ | 72 | 1.4 | % | ||||||||||||||
Ambulatory Care | 24 | 24 | — | % | ||||||||||||||||
Conifer | 2 | 3 | (33.3) | % | ||||||||||||||||
Total | $ | 99 | $ | 99 | — | % |
(1) | Included in other operating expenses. |
Continuing Operations Three Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||
Selected Operating Expenses per Adjusted Patient Admission | 2021 | 2020 | ||||||||||||||||||
Hospital Operations: | ||||||||||||||||||||
Salaries, wages and benefits per adjusted patient admission(1) | $ | 7,308 | $ | 7,054 | 3.6 | % | ||||||||||||||
Supplies per adjusted patient admission(1) | 2,563 | 2,546 | 0.7 | % | ||||||||||||||||
Other operating expenses per adjusted patient admission(1) | 3,488 | 3,487 | — | % | ||||||||||||||||
Total per adjusted patient admission | $ | 13,359 | $ | 13,087 | 2.1 | % |
(1) | Adjusted patient admissions represents actual patient admissions adjusted to include outpatient services provided by facilities in our Hospital Operations segment by multiplying actual patient admissions by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues. |
Net Patient Service Revenues Less Implicit Price Concessions from: | Three Months Ended September 30, | Increase (Decrease)(1) | Nine Months Ended September 30, | Increase (Decrease)(1) | ||||||||||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||||||||||||||
Medicare | 16.6 | % | 18.9 | % | (2.3) | % | 18.0 | % | 19.9 | % | (1.9) | % | ||||||||||||||||||||||||||
Medicaid | 9.0 | % | 7.1 | % | 1.9 | % | 7.9 | % | 8.0 | % | (0.1) | % | ||||||||||||||||||||||||||
Managed care(2) | 69.2 | % | 67.7 | % | 1.5 | % | 68.1 | % | 66.0 | % | 2.1 | % | ||||||||||||||||||||||||||
Uninsured | 0.9 | % | 1.4 | % | (0.5) | % | 1.3 | % | 1.1 | % | 0.2 | % | ||||||||||||||||||||||||||
Indemnity and other | 4.3 | % | 4.9 | % | (0.6) | % | 4.7 | % | 5.0 | % | (0.3) | % |
(1) | The change is the difference between the 2021 and 2020 percentages shown. | |||||||
(2) | Includes Medicare and Medicaid managed care programs. |
Three Months Ended September 30, | Increase (Decrease)(1) | Nine Months Ended September 30, | Increase (Decrease)(1) | |||||||||||||||||||||||||||||||||||
Admissions from: | 2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||||||||||
Medicare | 19.6 | % | 21.9 | % | (2.3) | % | 20.6 | % | 23.0 | % | (2.4) | % | ||||||||||||||||||||||||||
Medicaid | 6.1 | % | 6.4 | % | (0.3) | % | 5.8 | % | 6.3 | % | (0.5) | % | ||||||||||||||||||||||||||
Managed care(2) | 65.2 | % | 62.7 | % | 2.5 | % | 64.4 | % | 61.6 | % | 2.8 | % | ||||||||||||||||||||||||||
Charity and uninsured | 5.8 | % | 6.2 | % | (0.4) | % | 6.0 | % | 6.3 | % | (0.3) | % | ||||||||||||||||||||||||||
Indemnity and other | 3.3 | % | 2.8 | % | 0.5 | % | 3.2 | % | 2.8 | % | 0.4 | % |
(1) | The change is the difference between the 2021 and 2020 percentages shown. | |||||||
(2) | Includes Medicare and Medicaid managed care programs. |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Estimated costs for: | ||||||||||||||||||||||||||
Uninsured patients | $ | $ | $ | $ | ||||||||||||||||||||||
Charity care patients | ||||||||||||||||||||||||||
Total | $ | $ | $ | $ | ||||||||||||||||||||||
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||
Net operating revenues: | |||||||||||||||||||||||
Hospital Operations | $ | 4,030 | $ | 3,803 | $ | 12,072 | $ | 10,725 | |||||||||||||||
Ambulatory Care | 666 | 565 | 1,976 | 1,423 | |||||||||||||||||||
Conifer | 314 | 325 | 943 | 962 | |||||||||||||||||||
Inter-segment eliminations | (116) | (136) | (362) | (385) | |||||||||||||||||||
Net operating revenues | 4,894 | 4,557 | 14,629 | 12,725 | |||||||||||||||||||
Grant income | 3 | (66) | 53 | 445 | |||||||||||||||||||
Equity in earnings of unconsolidated affiliates | 45 | 44 | 141 | 103 | |||||||||||||||||||
Operating expenses: | |||||||||||||||||||||||
Salaries, wages and benefits | 2,209 | 2,142 | 6,690 | 6,193 | |||||||||||||||||||
Supplies | 827 | 784 | 2,490 | 2,158 | |||||||||||||||||||
Other operating expenses, net | 1,051 | 1,058 | 3,177 | 3,054 | |||||||||||||||||||
Depreciation and amortization | 209 | 215 | 654 | 624 | |||||||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | 15 | 57 | 55 | 166 | |||||||||||||||||||
Litigation and investigation costs | 29 | 9 | 64 | 13 | |||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | (412) | (1) | (427) | (4) | |||||||||||||||||||
Operating income | $ | 1,014 | $ | 271 | $ | 2,120 | $ | 1,069 | |||||||||||||||
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||
Net operating revenues | 100.0 | % | 100.0 | % | 100.0 | % | 100.0 | % | |||||||||||||||
Grant income | 0.1 | % | (1.4) | % | 0.4 | % | 3.5 | % | |||||||||||||||
Equity in earnings of unconsolidated affiliates | 0.9 | % | 1.0 | % | 1.0 | % | 0.8 | % | |||||||||||||||
Operating expenses: | |||||||||||||||||||||||
Salaries, wages and benefits | 45.1 | % | 47.1 | % | 45.8 | % | 48.6 | % | |||||||||||||||
Supplies | 16.9 | % | 17.2 | % | 17.0 | % | 17.0 | % | |||||||||||||||
Other operating expenses, net | 21.5 | % | 23.2 | % | 21.7 | % | 24.0 | % | |||||||||||||||
Depreciation and amortization | 4.3 | % | 4.7 | % | 4.5 | % | 4.9 | % | |||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | 0.3 | % | 1.3 | % | 0.4 | % | 1.3 | % | |||||||||||||||
Litigation and investigation costs | 0.6 | % | 0.2 | % | 0.4 | % | 0.1 | % | |||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | (8.4) | % | — | % | (2.9) | % | — | % | |||||||||||||||
Operating income | 20.7 | % | 5.9 | % | 14.5 | % | 8.4 | % |
Three Months Ended September 30, | Increase (Decrease) | Nine Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||||||||||||||||||
Selected Operating Expenses | 2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||||||||||
Hospital Operations — Same-Hospital: | ||||||||||||||||||||||||||||||||||||||
Salaries, wages and benefits | $ | 1,827 | $ | 1,697 | 7.7 | % | $ | 5,397 | $ | 4,902 | 10.1 | % | ||||||||||||||||||||||||||
Supplies | 638 | 613 | 4.1 | % | 1,885 | 1,722 | 9.5 | % | ||||||||||||||||||||||||||||||
Other operating expenses | 850 | 818 | 3.9 | % | 2,513 | 2,384 | 5.4 | % | ||||||||||||||||||||||||||||||
Total | $ | 3,315 | $ | 3,128 | 6.0 | % | $ | 9,795 | $ | 9,008 | 8.7 | % | ||||||||||||||||||||||||||
Ambulatory Care: | ||||||||||||||||||||||||||||||||||||||
Salaries, wages and benefits | $ | 169 | $ | 157 | 7.6 | % | $ | 512 | $ | 438 | 16.9 | % | ||||||||||||||||||||||||||
Supplies | 170 | 128 | 32.8 | % | 496 | 319 | 55.5 | % | ||||||||||||||||||||||||||||||
Other operating expenses | 97 | 97 | — | % | 295 | 258 | 14.3 | % | ||||||||||||||||||||||||||||||
Total | $ | 436 | $ | 382 | 14.1 | % | $ | 1,303 | $ | 1,015 | 28.4 | % | ||||||||||||||||||||||||||
Conifer: | ||||||||||||||||||||||||||||||||||||||
Salaries, wages and benefits | $ | 168 | $ | 167 | 0.6 | % | $ | 508 | $ | 511 | (0.6) | % | ||||||||||||||||||||||||||
Supplies | 1 | — | N/A | 3 | 2 | 50.0 | % | |||||||||||||||||||||||||||||||
Other operating expenses | 60 | 62 | (3.2) | % | 171 | 193 | (11.4) | % | ||||||||||||||||||||||||||||||
Total | $ | 229 | $ | 229 | — | % | $ | 682 | $ | 706 | (3.4) | % | ||||||||||||||||||||||||||
Rent/lease expense(1): | ||||||||||||||||||||||||||||||||||||||
Hospital Operations | $ | 69 | $ | 66 | 4.5 | % | $ | 210 | $ | 188 | 11.7 | % | ||||||||||||||||||||||||||
Ambulatory Care | 24 | 24 | — | % | 75 | 67 | 11.9 | % | ||||||||||||||||||||||||||||||
Conifer | 2 | 3 | (33.3) | % | 8 | 9 | (11.1) | % | ||||||||||||||||||||||||||||||
Total | $ | 95 | $ | 93 | 2.2 | % | $ | 293 | $ | 264 | 11.0 | % |
(1) | Included in other operating expenses. |
Same-Hospital Continuing Operations | Same-Hospital Continuing Operations | |||||||||||||||||||||||||||||||||||||||||||
Three Months Ended September 30, | Increase (Decrease) | Nine Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||||||||||||||||||||||||
Admissions, Patient Days and Surgeries | 2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||||||||||||||||
Number of hospitals (at end of period) | 60 | 60 | — | (1) | 60 | 60 | — | (1) | ||||||||||||||||||||||||||||||||||||
Total admissions | 140,491 | 136,895 | 2.6 | % | 413,942 | 409,382 | 1.1 | % | ||||||||||||||||||||||||||||||||||||
Adjusted patient admissions(2) | 248,798 | 238,372 | 4.4 | % | 732,540 | 709,736 | 3.2 | % | ||||||||||||||||||||||||||||||||||||
Paying admissions (excludes charity and uninsured) | 132,614 | 129,350 | 2.5 | % | 391,432 | 386,552 | 1.3 | % | ||||||||||||||||||||||||||||||||||||
Charity and uninsured admissions | 7,877 | 7,545 | 4.4 | % | 22,510 | 22,830 | (1.4) | % | ||||||||||||||||||||||||||||||||||||
Admissions through emergency department | 106,217 | 99,966 | 6.3 | % | 309,681 | 295,582 | 4.8 | % | ||||||||||||||||||||||||||||||||||||
Paying admissions as a percentage of total admissions | 94.4 | % | 94.5 | % | (0.1) | % | (1) | 94.6 | % | 94.4 | % | 0.2 | % | (1) | ||||||||||||||||||||||||||||||
Charity and uninsured admissions as a percentage of total admissions | 5.6 | % | 5.5 | % | 0.1 | % | (1) | 5.4 | % | 5.6 | % | (0.2) | % | (1) | ||||||||||||||||||||||||||||||
Emergency department admissions as a percentage of total admissions | 75.6 | % | 73.0 | % | 2.6 | % | (1) | 74.8 | % | 72.2 | % | 2.6 | % | (1) | ||||||||||||||||||||||||||||||
Surgeries — inpatient | 35,535 | 37,009 | (4.0) | % | 106,994 | 108,272 | (1.2) | % | ||||||||||||||||||||||||||||||||||||
Surgeries — outpatient | 54,119 | 51,785 | 4.5 | % | 161,982 | 139,031 | 16.5 | % | ||||||||||||||||||||||||||||||||||||
Total surgeries | 89,654 | 88,794 | 1.0 | % | 268,976 | 247,303 | 8.8 | % | ||||||||||||||||||||||||||||||||||||
Patient days — total | 748,012 | 710,369 | 5.3 | % | 2,174,982 | 2,072,369 | 5.0 | % | ||||||||||||||||||||||||||||||||||||
Adjusted patient days(2) | 1,301,989 | 1,198,744 | 8.6 | % | 3,762,149 | 3,481,388 | 8.1 | % | ||||||||||||||||||||||||||||||||||||
Average length of stay (days) | 5.32 | 5.19 | 2.5 | % | 5.25 | 5.06 | 3.8 | % | ||||||||||||||||||||||||||||||||||||
Licensed beds (at end of period) | 15,399 | 15,467 | (0.4) | % | 15,399 | 15,467 | (0.4) | % | ||||||||||||||||||||||||||||||||||||
Average licensed beds | 15,399 | 15,467 | (0.4) | % | 15,401 | 15,451 | (0.3) | % | ||||||||||||||||||||||||||||||||||||
Utilization of licensed beds(3) | 52.8 | % | 49.9 | % | 2.9 | % | (1) | 51.7 | % | 49.0 | % | 2.7 | % | (1) |
(1) | The change is the difference between the 2021 and 2020 amounts shown. | |||||||
(2) | Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues. | |||||||
(3) | Utilization of licensed beds represents patient days divided by number of days in the period divided by average licensed beds. |
Same-Hospital Continuing Operations | Same-Hospital Continuing Operations | |||||||||||||||||||||||||||||||||||||||||||
Three Months Ended September 30, | Increase (Decrease) | Nine Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||||||||||||||||||||||||
Outpatient Visits | 2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||||||||||||||||
Total visits | 1,360,953 | 1,180,516 | 15.3 | % | 4,008,056 | 3,392,446 | 18.1 | % | ||||||||||||||||||||||||||||||||||||
Paying visits (excludes charity and uninsured) | 1,265,603 | 1,105,627 | 14.5 | % | 3,736,175 | 3,153,510 | 18.5 | % | ||||||||||||||||||||||||||||||||||||
Charity and uninsured visits | 95,350 | 74,889 | 27.3 | % | 271,881 | 238,936 | 13.8 | % | ||||||||||||||||||||||||||||||||||||
Emergency department visits | 567,260 | 438,772 | 29.3 | % | 1,502,651 | 1,406,380 | 6.8 | % | ||||||||||||||||||||||||||||||||||||
Surgery visits | 54,119 | 51,785 | 4.5 | % | 161,982 | 139,031 | 16.5 | % | ||||||||||||||||||||||||||||||||||||
Paying visits as a percentage of total visits | 93.0 | % | 93.7 | % | (0.7) | % | (1) | 93.2 | % | 93.0 | % | 0.2 | % | (1) | ||||||||||||||||||||||||||||||
Charity and uninsured visits as a percentage of total visits | 7.0 | % | 6.3 | % | 0.7 | % | (1) | 6.8 | % | 7.0 | % | (0.2) | % | (1) |
(1) | The change is the difference between the 2021 and 2020 amounts shown. |
Same-Hospital Continuing Operations | Same-Hospital Continuing Operations | |||||||||||||||||||||||||||||||||||||
Three Months Ended September 30, | Increase (Decrease) | Nine Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||||||||||||||||||
Revenues | 2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||||||||||
Total segment net operating revenues(1) | $ | 3,799 | $ | 3,399 | 11.8 | % | $ | 11,050 | $ | 9,615 | 14.9 | % | ||||||||||||||||||||||||||
Selected revenue data – hospitals and related outpatient facilities: | ||||||||||||||||||||||||||||||||||||||
Net patient service revenues(1)(2) | $ | 3,599 | $ | 3,246 | 10.9 | % | $ | 10,498 | $ | 9,170 | 14.5 | % | ||||||||||||||||||||||||||
Net patient service revenue per adjusted patient admission(1)(2) | $ | 14,466 | $ | 13,617 | 6.2 | % | $ | 14,331 | $ | 12,920 | 10.9 | % | ||||||||||||||||||||||||||
Net patient service revenue per adjusted patient day(1)(2) | $ | 2,764 | $ | 2,708 | 2.1 | % | $ | 2,790 | $ | 2,634 | 5.9 | % |
(1) | Revenues are net of implicit price concessions. | |||||||
(2) | Adjusted patient admissions/days represents actual patient admissions/days adjusted to include outpatient services provided by facilities in our Hospital Operations segment by multiplying actual patient admissions/days by the sum of gross inpatient revenues and outpatient revenues and dividing the results by gross inpatient revenues. |
Same-Hospital Continuing Operations | Same-Hospital Continuing Operations | |||||||||||||||||||||||||||||||||||||||||||
Three Months Ended September 30, | Increase (Decrease) | Nine Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||||||||||||||||||||||||
Total Segment Selected Operating Expenses | 2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||||||||||||||||
Salaries, wages and benefits as a percentage of net operating revenues | 48.1 | % | 49.9 | % | (1.8) | % | (1) | 48.8 | % | 51.0 | % | (2.2) | % | (1) | ||||||||||||||||||||||||||||||
Supplies as a percentage of net operating revenues | 16.8 | % | 18.0 | % | (1.2) | % | (1) | 17.1 | % | 17.9 | % | (0.8) | % | (1) | ||||||||||||||||||||||||||||||
Other operating expenses as a percentage of net operating revenues | 22.4 | % | 24.1 | % | (1.7) | % | (1) | 22.7 | % | 24.8 | % | (2.1) | % | (1) |
(1) | The change is the difference between the 2021 and 2020 amounts shown. |
September 30, 2021 | December 31, 2020 | |||||||||||||
Medicare | $ | 150 | $ | 152 | ||||||||||
Medicaid | 53 | 49 | ||||||||||||
Net cost report settlements receivable and valuation allowances | 44 | 34 | ||||||||||||
Managed care | 1,607 | 1,567 | ||||||||||||
Self-pay uninsured | 22 | 32 | ||||||||||||
Self-pay balance after insurance | 72 | 74 | ||||||||||||
Estimated future recoveries | 139 | 156 | ||||||||||||
Other payers | 341 | 318 | ||||||||||||
Total Hospital Operations | 2,428 | 2,382 | ||||||||||||
Ambulatory Care | 313 | 307 | ||||||||||||
Total discontinued operations | 1 | 1 | ||||||||||||
Accounts receivable, net | $ | 2,742 | $ | 2,690 |
September 30, 2021 | ||||||||||||||||||||||||||||||||
Medicare | Medicaid | Managed Care | Indemnity, Self-Pay and Other | Total | ||||||||||||||||||||||||||||
0-60 days | 92 | % | 48 | % | 57 | % | 23 | % | 51 | % | ||||||||||||||||||||||
61-120 days | 4 | % | 24 | % | 16 | % | 14 | % | 15 | % | ||||||||||||||||||||||
121-180 days | 2 | % | 11 | % | 9 | % | 9 | % | 9 | % | ||||||||||||||||||||||
Over 180 days | 2 | % | 17 | % | 18 | % | 54 | % | 25 | % | ||||||||||||||||||||||
Total | 100 | % | 100 | % | 100 | % | 100 | % | 100 | % |
December 31, 2020 | ||||||||||||||||||||||||||||||||
Medicare | Medicaid | Managed Care | Indemnity, Self-Pay and Other | Total | ||||||||||||||||||||||||||||
0-60 days | 91 | % | 33 | % | 58 | % | 24 | % | 52 | % | ||||||||||||||||||||||
61-120 days | 5 | % | 31 | % | 15 | % | 13 | % | 14 | % | ||||||||||||||||||||||
121-180 days | 2 | % | 14 | % | 8 | % | 8 | % | 8 | % | ||||||||||||||||||||||
Over 180 days | 2 | % | 22 | % | 19 | % | 55 | % | 26 | % | ||||||||||||||||||||||
Total | 100 | % | 100 | % | 100 | % | 100 | % | 100 | % |
September 30, 2021 | December 31, 2020 | |||||||||||||
0-60 days | $ | 76 | $ | 91 | ||||||||||
61-120 days | 12 | 24 | ||||||||||||
121-180 days | 5 | 6 | ||||||||||||
Over 180 days | 6 | 6 | ||||||||||||
Total | $ | 99 | $ | 127 |
Three Months Ended September 30, | Increase (Decrease) | Nine Months Ended September 30, | Increase (Decrease) | |||||||||||||||||||||||||||||||||||
Ambulatory Care Results of Operations | 2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||||||||||
Net operating revenues | $ | 666 | $ | 565 | 17.9 | % | $ | 1,976 | $ | 1,423 | 38.9 | % | ||||||||||||||||||||||||||
Grant income | $ | 1 | $ | (9) | 111.1 | % | $ | 23 | $ | 28 | (17.9) | % | ||||||||||||||||||||||||||
Equity in earnings of unconsolidated affiliates | $ | 43 | $ | 41 | 4.9 | % | $ | 130 | $ | 102 | 27.5 | % | ||||||||||||||||||||||||||
Salaries, wages and benefits | $ | 169 | $ | 157 | 7.6 | % | $ | 512 | $ | 438 | 16.9 | % | ||||||||||||||||||||||||||
Supplies | $ | 170 | $ | 128 | 32.8 | % | $ | 496 | $ | 319 | 55.5 | % | ||||||||||||||||||||||||||
Other operating expenses, net | $ | 97 | $ | 97 | — | % | $ | 295 | $ | 258 | 14.3 | % |
Ambulatory Care Facility Growth | Three Months Ended September 30, 2021 | Nine Months Ended September 30, 2021 | |||||||||||||||
Net revenues | 4.2% | 17.4% | |||||||||||||||
Cases | 6.8% | 20.4% | |||||||||||||||
Net revenue per case | (2.5)% | (2.5)% |
Ambulatory Care Facilities | Nine Months Ended September 30, 2021 | ||||||||||
Facilities: | |||||||||||
With a health system partner | 192 | ||||||||||
Without a health system partner | 150 | ||||||||||
Total facilities operated | 342 | ||||||||||
Change from December 31, 2020: | |||||||||||
Acquisitions | 8 | ||||||||||
De novo | 3 | ||||||||||
Dispositions/Mergers | (65) | ||||||||||
Total decrease in number of facilities operated | (54) |
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Tax expense (benefit) at statutory federal rate of 21% | $ | 163 | $ | (64) | $ | 286 | $ | (1) | ||||||||||||||||||
State income taxes, net of federal income tax benefit | 29 | (6) | 56 | 9 | ||||||||||||||||||||||
Tax benefit attributable to noncontrolling interests | (26) | (18) | (79) | (48) | ||||||||||||||||||||||
Nondeductible goodwill | 28 | — | 35 | — | ||||||||||||||||||||||
Nontaxable gains | — | — | — | 3 | ||||||||||||||||||||||
Stock-based compensation | (1) | 1 | (4) | 1 | ||||||||||||||||||||||
Change in valuation allowance | — | (113) | — | (201) | ||||||||||||||||||||||
Other items | 4 | 3 | 9 | 10 | ||||||||||||||||||||||
Income tax expense (benefit) | $ | 197 | $ | (197) | $ | 303 | $ | (227) |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | ||||||||||||||||||||||||||
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders | $ | 449 | $ | (196) | $ | 665 | $ | (15) | |||||||||||||||||||||
Less: Net income available to noncontrolling interests | (129) | (90) | (392) | (237) | |||||||||||||||||||||||||
Income from discontinued operations, net of tax | 1 | 1 | — | — | |||||||||||||||||||||||||
Income (loss) from continuing operations | 577 | (107) | 1,057 | 222 | |||||||||||||||||||||||||
Income tax benefit (expense) | (197) | 197 | (303) | 227 | |||||||||||||||||||||||||
Loss from early extinguishment of debt | (20) | (312) | (74) | (316) | |||||||||||||||||||||||||
Other non-operating income, net | 7 | — | 16 | 3 | |||||||||||||||||||||||||
Interest expense | (227) | (263) | (702) | (761) | |||||||||||||||||||||||||
Operating income | 1,014 | 271 | 2,120 | 1,069 | |||||||||||||||||||||||||
Litigation and investigation costs | (29) | (9) | (64) | (13) | |||||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | 412 | 1 | 427 | 4 | |||||||||||||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | (15) | (57) | (55) | (166) | |||||||||||||||||||||||||
Depreciation and amortization | (209) | (215) | (654) | (624) | |||||||||||||||||||||||||
Adjusted EBITDA | $ | 855 | $ | 551 | $ | 2,466 | $ | 1,868 | |||||||||||||||||||||
Net operating revenues | $ | 4,894 | $ | 4,557 | $ | 14,629 | $ | 12,725 | |||||||||||||||||||||
Net income available (loss attributable) to Tenet Healthcare Corporation common shareholders as a % of net operating revenues | 9.2 | % | (4.3) | % | 4.5 | % | (0.1) | % | |||||||||||||||||||||
Adjusted EBITDA as % of net operating revenues (Adjusted EBITDA margin) | 17.5 | % | 12.1 | % | 16.9 | % | 14.7 | % |
Maturity Date, Years Ending December 31, | ||||||||||||||||||||||||||||||||||||||||||||||||||
2021 | 2022 | 2023 | 2024 | 2025 | Thereafter | Total | Fair Value | |||||||||||||||||||||||||||||||||||||||||||
(Dollars in Millions) | ||||||||||||||||||||||||||||||||||||||||||||||||||
Fixed rate long-term debt | $ | 40 | $ | 115 | $ | 1,950 | $ | 1,409 | $ | 722 | $ | 10,040 | $ | 14,276 | $ | 14,879 | ||||||||||||||||||||||||||||||||||
Average effective interest rates | 4.1 | % | 4.1 | % | 6.7 | % | 4.6 | % | 7.5 | % | 5.4 | % | 5.6 | % | ||||||||||||||||||||||||||||||||||||
(10) | Material Contracts | ||||||||||
(a) | |||||||||||
(b) | |||||||||||
(31) | Rule 13a-14(a)/15d-14(a) Certifications | ||||||||||
(a) | |||||||||||
(b) | |||||||||||
(32) | |||||||||||
(101 SCH) | Inline XBRL Taxonomy Extension Schema Document | ||||||||||
(101 CAL) | Inline XBRL Taxonomy Extension Calculation Linkbase Document | ||||||||||
(101 DEF) | Inline XBRL Taxonomy Extension Definition Linkbase Document | ||||||||||
(101 LAB) | Inline XBRL Taxonomy Extension Label Linkbase Document | ||||||||||
(101 PRE) | Inline XBRL Taxonomy Extension Presentation Linkbase Document | ||||||||||
(101 INS) | Inline XBRL Taxonomy Extension Instance Document - the instance document does not appear in the interactive data file because its XBRL tags are embedded within the inline XBRL document | ||||||||||
(104) | Cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2021 formatted in Inline XBRL (included in Exhibit 101) | ||||||||||
* Management contract or compensatory plan or arrangement |
TENET HEALTHCARE CORPORATION (Registrant) | ||||||||
Date: October 29, 2021 | By: | /s/ R. SCOTT RAMSEY | ||||||
R. Scott Ramsey | ||||||||
Senior Vice President, Controller | ||||||||
(Principal Accounting Officer) |
Date: October 29, 2021 | /s/ SAUMYA SUTARIA | ||||
Saumya Sutaria, M.D. | |||||
Chief Executive Officer |
Date: October 29, 2021 | /s/ DANIEL J. CANCELMI | ||||
Daniel J. Cancelmi | |||||
Executive Vice President and Chief Financial Officer |
Date: October 29, 2021 | /s/ SAUMYA SUTARIA | ||||
Saumya Sutaria, M.D. | |||||
Chief Executive Officer | |||||
Date: October 29, 2021 | /s/ DANIEL J. CANCELMI | ||||
Daniel J. Cancelmi | |||||
Executive Vice President and Chief Financial Officer |
CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Millions |
Sep. 30, 2021 |
Dec. 31, 2020 |
---|---|---|
Statement of Financial Position [Abstract] | ||
Property and equipment, accumulated depreciation and amortization | $ 5,872 | $ 6,043 |
Other intangible assets, accumulated amortization | $ 1,326 | $ 1,284 |
Common stock, par value (in dollars per share) | $ 0.05 | $ 0.05 |
Common stock, authorized shares (in shares) | 262,500,000 | 262,500,000 |
Common stock, shares issued (in shares) | 155,402,362 | 154,407,524 |
Common stock in treasury (in shares) | 48,333,196 | 48,337,947 |
CONDENSED CONSOLIDATED STATEMENTS OF OTHER COMPREHENSIVE INCOME - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Statement of Comprehensive Income [Abstract] | ||||
Net income (loss) | $ 578 | $ (106) | $ 1,057 | $ 222 |
Other comprehensive income: | ||||
Amortization of net actuarial loss included in other non-operating income, net | 2 | 2 | 8 | 6 |
Unrealized gains on debt securities held as available-for-sale | 0 | 0 | 0 | 1 |
Foreign currency translation adjustments | 1 | 0 | 1 | 0 |
Other comprehensive income before income taxes | 3 | 2 | 9 | 7 |
Income tax benefit (expense) related to items of other comprehensive income | 0 | 2 | (2) | (1) |
Total other comprehensive income, net of tax | 3 | 4 | 7 | 6 |
Comprehensive net income (loss) | 581 | (102) | 1,064 | 228 |
Less: Comprehensive income available to noncontrolling interests | 129 | 90 | 392 | 237 |
Comprehensive income available (loss attributable) to Tenet Healthcare Corporation common shareholders | $ 452 | $ (192) | $ 672 | $ (9) |
BASIS OF PRESENTATION |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Organization, Consolidation and Presentation of Financial Statements [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
BASIS OF PRESENTATION | BASIS OF PRESENTATION Description of Business and Basis of Presentation Tenet Healthcare Corporation (together with our subsidiaries, referred to herein as “Tenet,” “we,” “our” or “us”) is a diversified healthcare services company headquartered in Dallas, Texas. Through an expansive care network that includes USPI Holding Company, Inc. (“USPI”), at September 30, 2021 we operated 60 hospitals and approximately 460 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, imaging centers, and other care sites and clinics. We also operate Conifer Health Solutions, LLC through our Conifer Holdings, Inc. (“Conifer”) subsidiary, which provides revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients. This quarterly report supplements our Annual Report on Form 10‑K for the year ended December 31, 2020 (“Annual Report”). As permitted by the Securities and Exchange Commission for interim reporting, we have omitted certain notes and disclosures that substantially duplicate those in our Annual Report. For further information, refer to the audited Consolidated Financial Statements and notes included in our Annual Report. Unless otherwise indicated, all financial and statistical data included in these notes to our Condensed Consolidated Financial Statements relate to our continuing operations, with dollar amounts expressed in millions (except per‑share amounts). Although the Condensed Consolidated Financial Statements and related notes within this document are unaudited, we believe all adjustments considered necessary for a fair presentation have been included and are of a normal recurring nature. In preparing our financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”), we are required to make estimates and assumptions that affect the amounts reported in our Condensed Consolidated Financial Statements and these accompanying notes. We regularly evaluate the accounting policies and estimates we use. In general, we base the estimates on historical experience and on assumptions that we believe to be reasonable given the particular circumstances in which we operate. Actual results may vary from those estimates. Financial and statistical information we report to other regulatory agencies may be prepared on a basis other than GAAP or using different assumptions or reporting periods and, therefore, may vary from amounts presented herein. Although we make every effort to ensure that the information we report to those agencies is accurate, complete and consistent with applicable reporting guidelines, we cannot be responsible for the accuracy of the information they make available to the public. Operating results for the three and nine‑month periods ended September 30, 2021 are not necessarily indicative of the results that may be expected for the full year. Reasons for this include, but are not limited to: the impact of the COVID‑19 pandemic on our operations, business, financial condition and cash flows; the impact of the demand for, and availability of, qualified medical personnel on compensation costs; overall revenue and cost trends, particularly the timing and magnitude of price changes; fluctuations in contractual allowances and cost report settlements and valuation allowances; managed care contract negotiations, settlements or terminations and payer consolidations; trends in patient accounts receivable collectability and associated implicit price concessions; fluctuations in interest rates; levels of malpractice insurance expense and settlement trends; impairment of long‑lived assets and goodwill; restructuring charges; losses, costs and insurance recoveries related to natural disasters and other weather‑related occurrences; litigation and investigation costs; acquisitions and dispositions of facilities and other assets; gains (losses) on sales, consolidation and deconsolidation of facilities; income tax rates and deferred tax asset valuation allowance activity; changes in estimates of accruals for annual incentive compensation; the timing and amounts of stock option and restricted stock unit grants to employees and directors; gains (losses) from early extinguishment of debt; and changes in occupancy levels and patient volumes. Factors that affect service mix, revenue mix, patient volumes and, thereby, the results of operations at our hospitals and related healthcare facilities include, but are not limited to: changes in federal, state and local healthcare and business regulations, including mandated closures and other operating restrictions; the business environment, economic conditions and demographics of local communities in which we operate; the number of uninsured and underinsured individuals in local communities treated at our hospitals; disease hotspots and seasonal cycles of illness; climate and weather conditions; physician recruitment, satisfaction, retention and attrition; advances in technology and treatments that reduce length of stay; local healthcare competitors; utilization pressure by managed care organizations, as well as managed care contract negotiations or terminations; hospital performance data on quality measures and patient satisfaction, as well as standard charges for services; any unfavorable publicity about us, or our joint venture partners, that impacts our relationships with physicians and patients; and changing consumer behavior, including with respect to the timing of elective procedures. These considerations apply to year‑to‑year comparisons as well. Certain prior‑year amounts have been reclassified to conform to the current year presentation. In the accompanying Condensed Consolidated Balance Sheets, income tax receivable has been reclassified to other current assets, as it is no longer significant enough to present separately. In the accompanying Condensed Consolidated Statements of Cash Flows, long‑term assets has been combined with other items, net, as it is no longer significant enough to present separately, but it remains located within cash flows from investing activities. COVID‑19 Pandemic During 2020, federal, state and local authorities undertook several actions designed to assist healthcare providers in providing care to COVID‑19 and other patients and to mitigate the adverse economic impact of the COVID‑19 pandemic. Legislative actions taken by the federal government during 2020 included the Coronavirus Aid, Relief, and Economic Security Act, the Paycheck Protection Program and Health Care Enhancement Act, the Continuing Appropriations Act, 2021 and Other Extensions Act, and the Consolidated Appropriations Act, 2021 (collectively, the “COVID Acts”). With the COVID Acts, the federal government authorized funding to be distributed through the Public Health and Social Services Emergency Fund (“Provider Relief Fund” or “PRF”). In June 2021, the U.S. Department of Health and Human Services (“HHS”) established new deadlines for when recipients of PRF grants must use the funding received, generally 12 to 18 months after receipt of the grant funds. HHS will recoup PRF grant funds not utilized by the established deadlines. The COVID Acts also revised the Medicare accelerated payment program in an attempt to disburse payments to hospitals and other care providers more quickly and permitted employers to defer payment of the 6.2% employer Social Security tax beginning March 27, 2020 through December 31, 2020. Our participation in these programs and the related accounting policies are summarized below. Grant Income. During the three and nine months ended September 30, 2021, we received cash payments of $2 million and $65 million, respectively, from the Provider Relief Fund and state and local grant programs, including $27 million received by our unconsolidated affiliates during the nine‑month period. During the three and nine months ended September 30, 2020, we received cash payments of $178 million and $890 million, respectively, from the Provider Relief Fund and state and local grant programs, including $4 million and $42 million received by our unconsolidated affiliates during the three and nine‑month periods, respectively. We recognize grant payments as income when there is reasonable assurance that we have complied with the conditions associated with the grant. Our estimates could change materially in the future based on our operating performance or COVID‑19 activities, as well as the government’s grant compliance guidance. Grant income recognized by our Hospital Operations and other (“Hospital Operations”) and Ambulatory Care segments is presented in grant income, and grant income recognized through our unconsolidated affiliates is presented in equity in earnings of unconsolidated affiliates in our statement of operations. During the three and nine months ended September 30, 2021, we recognized grant income of $2 million and $30 million, respectively, in our Hospital Operations segment, and $1 million and $23 million, respectively, in our Ambulatory Care segment. We recognized an additional $1 million and $12 million of Provider Relief Fund income during these periods, which was classified as equity in earnings of unconsolidated affiliates in the accompanying Condensed Consolidated Statements of Operations for the three and nine months ended September 30, 2021, respectively. During the three and nine months ended September 30, 2020, we recognized net grant income of $(57) million and $417 million, respectively, in our Hospital Operations segment, and $(9) million and $28 million, respectively, in our Ambulatory Care segment. Additionally, we recognized $(4) million and $8 million, respectively, of net grant income as equity in earnings of unconsolidated affiliates during the three and nine months ended September 30, 2020. We recognized a reduction of grant income in the three months ended September 30, 2020 to comply with revised grant guidelines HHS published in September 2020. At September 30, 2021 and December 31, 2020, we had deferred grant payments remaining of $3 million and $18 million, respectively, which amounts were recorded in other current liabilities in the accompanying Condensed Consolidated Balance Sheets for those periods. Medicare Accelerated Payment Program. In certain circumstances, when a hospital is experiencing financial difficulty due to delays in receiving payment for the Medicare services it provided, it may be eligible for an accelerated or advance payment pursuant to the Medicare accelerated payment program. The COVID Acts revised the Medicare accelerated payment program in an attempt to disburse payments to healthcare providers more quickly. Recipients may retain the accelerated payments for one year from the date of receipt before recoupment commences, which is effectuated by a 25% offset of claims payments for 11 months, followed by a 50% offset for the succeeding six months. At the end of the 29‑month period, interest on the unpaid balance will be assessed at 4.00% per annum. The initial 11‑month recoupment period began in April 2021. Our Hospital Operations and Ambulatory Care segments both received advance payments from the Medicare accelerated payment program during 2020. No additional advances were received in the nine months ended September 30, 2021. During the three and nine months ended September 30, 2021, $161 million and $302 million, respectively, of advances received by our Hospital Operations segment and $13 million and $24 million, respectively, of advances received by our Ambulatory Care segment were recouped through a reduction of our Medicare claims payments. In addition, $14 million and $26 million of advances received by unconsolidated affiliates for which we provide cash management services were recouped through a reduction of those affiliates’ Medicare claims payments during the same three and nine-month periods, respectively. In the accompanying Condensed Consolidated Balance Sheets, advances totaling $1.144 billion and $603 million were included in contract liabilities at September 30, 2021 and December 31, 2020, respectively, and advances totaling $902 million were included in contract liabilities – long term at December 31, 2020. Deferral of Employer Payroll Tax Match Payments. Social Security taxes deferred under the COVID Acts are required to be paid in equal amounts over two years, with payments due in December 2021 and December 2022. We had deferred Social Security tax payments totaling $130 million included in accrued compensation and benefits and $130 million included in other long‑term liabilities in the accompanying Condensed Consolidated Balance Sheets at both September 30, 2021 and December 31, 2020. Cash and Cash Equivalents We treat highly liquid investments with original maturities of three months or less as cash equivalents. Cash and cash equivalents were $2.292 billion and $2.446 billion at September 30, 2021 and December 31, 2020, respectively. At September 30, 2021 and December 31, 2020, our book overdrafts were $155 million and $154 million, respectively, which were classified as accounts payable. At September 30, 2021 and December 31, 2020, $169 million and $166 million, respectively, of total cash and cash equivalents in the accompanying Condensed Consolidated Balance Sheets were intended for the operations of our captive insurance subsidiaries. Also at September 30, 2021 and December 31, 2020, we had $51 million and $93 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $45 million and $85 million, respectively, were included in accounts payable. During the nine months ended September 30, 2021 and 2020, we recorded right‑of‑use assets related to non‑cancellable finance leases of $81 million and $75 million, respectively, and related to non‑cancellable operating leases of $121 million and $135 million, respectively. Other Intangible Assets The following tables provide information regarding other intangible assets, which were included in the accompanying Condensed Consolidated Balance Sheets at September 30, 2021 and December 31, 2020:
Estimated future amortization of intangibles with finite useful lives at September 30, 2021 is as follows:
We recognized amortization expense of $139 million and $127 million in the accompanying Condensed Consolidated Statements of Operations for the nine months ended September 30, 2021 and 2020, respectively. Investments in Unconsolidated Affiliates We control 232 of the facilities within our Ambulatory Care segment and, therefore, consolidate their results. We account for many of the facilities our Ambulatory Care segment operates (110 of 342 at September 30, 2021), as well as additional companies in which our Hospital Operations segment holds ownership interests, under the equity method as investments in unconsolidated affiliates and report only our share of net income as equity in earnings of unconsolidated affiliates in the accompanying Condensed Consolidated Statements of Operations. Equity in earnings of unconsolidated affiliates included $1 million and $12 million for the three and nine months ended September 30, 2021, respectively, from PRF grants recognized by our Ambulatory Care segment’s unconsolidated affiliates. During the three and nine months ended September 30, 2020, equity in earnings of unconsolidated affiliates included $(4) million and $8 million, respectively, from PRF grants recognized by these unconsolidated affiliates. During the three months ended September 30, 2020, we recognized a reduction of grant income reported in previous periods to comply with revised grant guidelines HHS published in September 2020. Summarized financial information for these equity method investees is included in the following table. For investments acquired during the reported periods, amounts reflect 100% of the investee’s results beginning on the date of our acquisition of the investment.
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Accounts Receivable Additional Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ACCOUNTS RECEIVABLE | ACCOUNTS RECEIVABLE The principal components of accounts receivable are shown in the table below:
The following table summarizes the amount and classification of assets and liabilities in the accompanying Condensed Consolidated Balance Sheets related to California’s provider fee program at September 30, 2021 and December 31, 2020:
The following table shows our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses) of caring for our uninsured and charity patients in the three and nine months ended September 30, 2021 and 2020:
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Revenue from Contract with Customer [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CONTRACT BALANCES | CONTRACT BALANCES Hospital Operations Segment Amounts related to services provided to patients for which we have not billed and that do not meet the conditions of unconditional right to payment at the end of the reporting period are contract assets. For our Hospital Operations segment, our contract assets include services that we have provided to patients who are still receiving inpatient care in our facilities at the end of the reporting period. Our Hospital Operations segment’s contract assets were included in other current assets in the accompanying Condensed Consolidated Balance Sheets at September 30, 2021 and December 31, 2020. Approximately 91% of our Hospital Operations segment’s contract assets meet the conditions for unconditional right to payment and are reclassified to patient receivables within 90 days. In certain circumstances, when a hospital is experiencing financial difficulty due to delays in receiving payment for the Medicare services it provided, it may be eligible for an accelerated or advance payment pursuant to the Medicare accelerated payment program. As discussed in Note 1, the COVID Acts revised the Medicare accelerated payment program in an attempt to disburse payments to hospitals more quickly. During the year ended December 31, 2020, our Hospital Operations segment received advance payments from the Medicare accelerated payment program following its expansion under the COVID Acts. These advance payments were recorded as contract liabilities in the accompanying Condensed Consolidated Balance Sheets at September 30, 2021 and December 31, 2020. No additional advances were received in the three and nine months ended September 30, 2021. The opening and closing balances of contract assets and contract liabilities for our Hospital Operations segment are as follows:
During the three and nine months ended September 30, 2021, $161 million and $302 million, respectively, of Medicare advance payments included in the opening contract liabilities balance for our Hospital Operations segment were recouped through a reduction of our Medicare claims payments. Ambulatory Care Segment During the year ended December 31, 2020, our Ambulatory Care segment also received advance payments from the expanded Medicare accelerated payment program. At September 30, 2021, contract liabilities in the accompanying Condensed Consolidated Balance Sheet included $78 million of Medicare advance payments received by our unconsolidated affiliates for whom we provide cash management services. At December 31, 2020, contract liabilities and contract liabilities – long‑term in the accompanying Condensed Consolidated Balance Sheet included $51 million and $62 million, respectively, of Medicare advance payments received by our unconsolidated affiliates for whom we provide cash management services. The opening and closing balances of contract liabilities for our Ambulatory Care segment are as follows:
During the three and nine months ended September 30, 2021, $13 million and $24 million, respectively, of Medicare advance payments included in the opening contract liabilities balance for our Ambulatory Care segment were recouped through a reduction of our Medicare claims payments. Additionally, $14 million and $26 million of Medicare advances received by our unconsolidated affiliates for whom we provide cash management services included in the opening contract liabilities balance were recouped during the three and nine months ended September 30, 2021, respectively. Conifer Segment Conifer enters into contracts with customers to provide revenue cycle management and other services, such as value‑based care, consulting and project services. The payment terms and conditions in our customer contracts vary. In some cases, customers are invoiced in advance and (for other than fixed‑price fee arrangements) a true‑up to the actual fee is included on a subsequent invoice. In other cases, payment is due in arrears. In addition, some contracts contain performance incentives, penalties and other forms of variable consideration. When the timing of Conifer’s delivery of services is different from the timing of payments made by the customers, Conifer recognizes either unbilled revenue (performance precedes contractual right to invoice the customer) or deferred revenue (customer payment precedes Conifer service performance). In the following table, customers that prepay prior to obtaining control/benefit of the service are represented by deferred contract revenue until the performance obligations are satisfied. Unbilled revenue represents arrangements in which Conifer has provided services to and the customer has obtained control/benefit of services prior to the contractual invoice date. Contracts with payment in arrears are recognized as receivables in the month the service is performed. The opening and closing balances of Conifer’s receivables, contract assets and contract liabilities are as follows:
The difference between the opening and closing balances of Conifer’s contract assets and contract liabilities are primarily related to prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are typically not distinct and are, therefore, recognized over the performance obligation period to which they relate. Our Conifer segment’s receivables and contract assets were reported as part of other current assets in our accompanying Condensed Consolidated Balance Sheets, and its current and long‑term contract liabilities were reported as part of contract liabilities and contract liabilities – long‑term, respectively, in our accompanying Condensed Consolidated Balance Sheets. In the nine months ended September 30, 2021 and 2020, Conifer recognized $56 million and $61 million, respectively, of revenue that was included in the opening current deferred revenue liability. This revenue consists primarily of prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are recognized over the services period. Contract Costs During the three months ended September 30, 2021 and 2020, we recognized amortization expense related to deferred contract setup costs of $1 million and $2 million, respectively. In the nine months ended September 30, 2021 and 2020, we recognized amortization expense related to deferred contract setup costs of $3 million and $4 million, respectively. At September 30, 2021 and December 31, 2020, the unamortized customer contract costs were $23 million and $24 million, respectively, and are presented as part of investments and other assets in the accompanying Condensed Consolidated Balance Sheets. NET OPERATING REVENUESNet operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact with Uninsured Patients and other uninsured discount and charity programs. Net operating revenues for our Conifer segment primarily consist of revenues from providing revenue cycle management services to health systems, as well as individual hospitals, physician practices, self‑insured organizations, health plans and other entities.The table below shows our sources of net operating revenues less implicit price concessions from continuing operations:
Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the nine months ended September 30, 2021 and 2020 by $21 million and $3 million, respectively. Estimated cost report settlements and valuation allowances were included in accounts receivable in the accompanying Condensed Consolidated Balance Sheets (see Note 2). We believe that we have made adequate provision for any adjustments that may result from final determination of amounts earned under all the above arrangements with Medicare and Medicaid. The table below shows the composition of net operating revenues for our Ambulatory Care segment:
The table below shows the composition of net operating revenues for our Conifer segment:
Other services represented approximately 8% and 7% of Conifer’s revenue for the nine months ended September 30, 2021 and 2020, respectively, and include value‑based care services, consulting services and other client‑defined projects. Performance Obligations The following table includes Conifer’s revenue that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, performance incentives, penalties or other variable consideration that is considered constrained. Conifer’s contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032.
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ASSETS AND LIABILITIES HELD FOR SALE |
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ASSETS AND LIABILITIES HELD FOR SALE | ASSETS AND LIABILITIES HELD FOR SALE We completed the sale of five Miami‑area hospitals and certain related operations held by our Hospital Operations segment in August 2021, resulting in our recognition of a pre‑tax gain on sale of $409 million in the three months ended September 30, 2021. In the three months ended June 30, 2021, we completed the sale of the majority of our urgent care centers operated under the MedPost and CareSpot brands by our Hospital Operations and Ambulatory Care segments. During the same three‑month period, we also completed the sale of a building we owned in the Philadelphia area that was held by our Hospital Operations segment. The assets and liabilities related to the urgent care centers and the building were classified as held for sale at December 31, 2020 in the accompanying Condensed Consolidated Balance Sheet. We recorded pre‑tax gains of $14 million and $2 million related to the sale of the urgent care centers and the sale of the building in Philadelphia, respectively, in the three months ended June 30, 2021. The table below provides information on significant components of our business that have been recently disposed of:
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IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS |
9 Months Ended |
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Sep. 30, 2021 | |
Restructuring Costs and Asset Impairment Charges [Abstract] | |
IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION-RELATED COSTS | IMPAIRMENT AND RESTRUCTURING CHARGES, AND ACQUISITION‑RELATED COSTS Our impairment tests presume stable, improving or, in some cases, declining operating results in our facilities, which are based on programs and initiatives being implemented that are designed to achieve each facility’s most recent projections. If these projections are not met, or if in the future negative trends occur that impact our future outlook, impairments of long‑lived assets and goodwill may occur, and we may incur additional restructuring charges, which could be material. At September 30, 2021, our continuing operations consisted of three reportable segments, Hospital Operations, Ambulatory Care and Conifer. Our segments are reporting units used to perform our goodwill impairment analysis. We periodically incur costs to implement restructuring efforts for specific operations, which are recorded in our statement of operations as they are incurred. Our restructuring plans focus on various aspects of operations, including aligning our operations in the most strategic and cost‑effective structure, such as the establishment of offshore support operations at our Global Business Center (“GBC”) in the Philippines. Certain restructuring and acquisition‑related costs are based on estimates. Changes in estimates are recognized as they occur. During the nine months ended September 30, 2021, we recorded impairment and restructuring charges and acquisition‑related costs of $55 million, consisting of $48 million of restructuring charges, $1 million of impairment charges and $6 million of acquisition‑related costs. Restructuring charges consisted of $13 million of employee severance costs, $16 million related to the transition of various administrative functions to our GBC and $19 million of other restructuring costs. Our impairment charges for the nine months ended September 30, 2021 were comprised of $1 million from our Ambulatory Care segment. Acquisition‑related costs consisted of $6 million of transaction costs. During the nine months ended September 30, 2020, we recorded impairment and restructuring charges and acquisition‑related costs of $166 million, consisting of $155 million of restructuring charges, $8 million of impairment charges and $3 million of acquisition‑related costs. Restructuring charges consisted of $53 million of employee severance costs, $40 million related to the transition of various administrative functions to our GBC, $23 million of charges due to the termination of USPI’s previous management equity plan, $15 million of contract and lease termination fees, and $24 million of other restructuring costs. Our impairment charges for the nine months ended September 30, 2020 were comprised of $5 million from our Ambulatory Care segment, $2 million from our Hospital Operations segment and $1 million from our Conifer segment. Acquisition‑related costs consisted of $3 million of transaction costs.
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LONG-TERM DEBT |
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Long-term Debt and Lease Obligation [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
LONG-TERM DEBT | LONG-TERM DEBT The table below shows our long‑term debt at September 30, 2021 and December 31, 2020:
Senior Unsecured Notes and Senior Secured Notes On September 10, 2021, we redeemed approximately $1.100 billion of the then outstanding $1.870 billion aggregate principal amount of our 4.625% senior secured first lien notes due 2024 in advance of their maturity date. We paid $1.113 billion to redeem the notes, which was primarily funded with the proceeds from the sale of five Miami‑area hospitals and certain related operations in August 2021. In connection with the redemption, we recorded a loss from early extinguishment of debt of $20 million in the three months ended September 30, 2021, primarily related to the difference between the purchase price and the par value of the notes, as well as the write‑off of associated unamortized issuance costs. On June 2, 2021, we issued $1.400 billion aggregate principal amount of 4.250% senior secured first lien notes, which will mature on June 1, 2029 (the “2029 Senior Secured First Lien Notes”). We will pay interest on the 2029 Senior Secured First Lien Notes semi‑annually in arrears on June 1 and December 1 of each year, commencing on December 1, 2021. The proceeds from the sale of the 2029 Senior Secured First Lien Notes were used, after payment of fees and expenses, together with cash on hand, to finance the redemption of all $1.410 billion aggregate principal amount then outstanding of our 5.125% senior secured second lien notes due 2025 (the “2025 Senior Secured Second Lien Notes”) in advance of their maturity date for approximately $1.428 billion. In connection with the redemption, we recorded a loss from early extinguishment of debt of approximately $31 million in the three months ended June 30, 2021, primarily related to the difference between the purchase price and the par value of the 2025 Senior Secured Second Lien Notes, as well as the write‑off of associated unamortized issuance costs. In March 2021, we retired all $478 million aggregate principal amount outstanding of our 7.000% senior unsecured notes due 2025 in advance of their maturity date. We paid approximately $495 million from cash on hand to retire the notes. In connection with the retirement, we recorded a loss from early extinguishment of debt of $23 million in the three months ended March 31, 2021, primarily related to the difference between the purchase price and the par value of the notes, as well as the write‑off of associated unamortized issuance costs. Credit Agreement We have a senior secured revolving credit facility that provides for revolving loans in an aggregate principal amount of up to $1.900 billion with a $200 million subfacility for standby letters of credit. We amended our credit agreement (as amended to date, the “Credit Agreement”) in April 2020 to, among other things, (i) increase the aggregate revolving credit commitments from the previous limit of $1.500 billion to $1.900 billion (the “Increased Commitments”), subject to borrowing availability, and (ii) increase the advance rate and raise limits on certain eligible accounts receivable in the calculation of the borrowing base, in each case, for an incremental period of 364 days. In April 2021, we further amended the Credit Agreement to, among other things, extend the availability of the Increased Commitments through April 22, 2022 and reduce the interest rate margins. At September 30, 2021, we had no cash borrowings outstanding under the Credit Agreement, and we had less than $1 million of standby letters of credit outstanding. Based on our eligible receivables, $1.802 billion was available for borrowing under the revolving credit facility at September 30, 2021. The Credit Agreement continues to have a scheduled maturity date of September 12, 2024, and obligations under the Credit Agreement continue to be guaranteed by substantially all of our domestic wholly owned hospital subsidiaries and secured by a first‑priority lien on the eligible inventory and accounts receivable owned by us and the subsidiary guarantors, including receivables for Medicaid supplemental payments. Outstanding revolving loans accrue interest at either (i) a base rate plus a margin ranging from 0.25% to 0.75% per annum, or (ii) the London Interbank Offered Rate (LIBOR) plus a margin ranging from 1.25% to 1.75% per annum, in each case based on available credit. An unused commitment fee payable on the undrawn portion of the revolving loans ranges from 0.25% to 0.375% per annum based on available credit. Our borrowing availability is based on a specified percentage of eligible inventory and accounts receivable, including self‑pay accounts. Letter of Credit Facility In March 2020, we amended our letter of credit facility (as amended, the “LC Facility”) to extend the scheduled maturity date of the LC Facility from March 7, 2021 to September 12, 2024 and to increase the aggregate principal amount of standby and documentary letters of credit that from time to time may be issued thereunder from $180 million to $200 million. On July 29, 2020, we further amended the LC Facility to incrementally increase the maximum secured debt covenant from 4.25 to 1.00 on a quarterly basis up to 6.00 to 1.00 for the quarter ended March 31, 2021, at which point the maximum ratio began to step down incrementally on a quarterly basis through the quarter ending December 31, 2021. At September 30, 2021, the effective maximum secured debt covenant was 5.00 to 1.00. Obligations under the LC Facility are guaranteed and secured by a first‑priority pledge of the capital stock and other ownership interests of certain of our wholly owned domestic hospital subsidiaries on an equal ranking basis with our senior secured first lien notes. Drawings under any letter of credit issued under the LC Facility that we have not reimbursed within three business days after notice thereof accrue interest at a base rate plus a margin of 0.50% per annum. An unused commitment fee is payable at an initial rate of 0.25% per annum with a step up to 0.375% per annum should our secured‑debt‑to‑EBITDA ratio equal or exceed 3.00 to 1.00 at the end of any fiscal quarter. A fee on the aggregate outstanding amount of issued but undrawn letters of credit accrues at a rate of 1.50% per annum. An issuance fee equal to 0.125% per annum of the aggregate face amount of each outstanding letter of credit is payable to the account of the issuer of the related letter of credit. At September 30, 2021, we had $139 million of standby letters of credit outstanding under the LC Facility.
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GUARANTEES |
9 Months Ended |
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Sep. 30, 2021 | |
Guarantees [Abstract] | |
GUARANTEES | GUARANTEES At September 30, 2021, the maximum potential amount of future payments under our income guarantees to certain physicians who agree to relocate and revenue collection guarantees to hospital‑based physician groups providing certain services at our hospitals was $156 million. We had a total liability of $108 million recorded for these guarantees included in other current liabilities in the accompanying Condensed Consolidated Balance Sheet at September 30, 2021. At September 30, 2021, we also had issued guarantees of the indebtedness and other obligations of our investees to third parties, the maximum potential amount of future payments under which was approximately $103 million. Of the total, $12 million relates to the obligations of consolidated subsidiaries, which obligations were recorded in the accompanying Condensed Consolidated Balance Sheet at September 30, 2021.
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EMPLOYEE BENEFIT PLANS |
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Share-based Payment Arrangement [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EMPLOYEE BENEFIT PLANS | EMPLOYEE BENEFIT PLANS Share-Based Compensation Plans The accompanying Condensed Consolidated Statements of Operations for the nine months ended September 30, 2021 and 2020 include $43 million and $38 million, respectively, of pre-tax compensation costs related to our stock‑based compensation arrangements. Stock Options The following table summarizes stock option activity during the nine months ended September 30, 2021:
There were 334,907 and 472,304 stock options exercised during the nine months ended September 30, 2021 and 2020, respectively, with aggregate intrinsic values of $12 million and $3 million, respectively. We did not grant any stock options during the nine months ended September 30, 2021 and 2020. At September 30, 2021, there were less than $1 million of total unrecognized compensation costs related to stock options. These costs are expected to be recognized over a weighted average period of less than one year. The following table summarizes information about our outstanding stock options at September 30, 2021:
Restricted Stock Units The following table summarizes activity with respect to restricted stock units (“RSUs”) during the nine months ended September 30, 2021:
In the nine months ended September 30, 2021, we granted an aggregate of 884,468 RSUs, consisting of 547,421 RSUs that vest based on the passage of time, 297,309 RSUs that vest on a contingent basis, and 39,738 RSUs that were granted to our non‑employee directors and vested immediately. Of the time‑based RSUs granted in the nine months ended September 30, 2021, 261,997 will vest and be settled ratably over a three‑year period from the grant date, 189,215 will vest and be settled ratably over eight quarterly periods from the grant date, 28,676 will vest and be settled on the third anniversary of the grant date, 53,341 will vest and be settled on the fourth anniversary of the grant date, and 14,192 will vest and be settled on December 31, 2021. The vesting of 243,076 of the performance‑based RSUs granted in the nine months ended September 30, 2021 is contingent on our achievement of specified performance goals for the years 2021 to 2023. Provided the goals are achieved, the performance‑based RSUs will vest and settle on the third anniversary of the grant date. The actual number of performance‑based RSUs that could vest will range from 0% to 200% of the 243,076 units granted, depending on our level of achievement with respect to the performance goals. We also granted 53,341 performance‑based RSUs to a senior officer in September 2021. The vesting of this grant is contingent on our achievement of specified performance goals for the years 2021 to 2025 and is subject to the same vesting range as the performance‑based grants described above. Provided the goals are achieved, the performance‑based RSUs issued in September 2021 will vest and settle on the fourth anniversary of the grant date. During the nine months ended September 30, 2021, we also granted 892 RSUs that vested and settled immediately as a result of our level of achievement with respect to performance‑based RSUs granted in 2018. The 39,738 RSUs granted to our non‑employee directors included 36,681 RSUs for the 2021‑2022 board service year, 1,372 for an initial grant to a new member of our board of directors and 1,685 for a pro‑rata annual grant to the same new member. While RSUs granted to our board of directors vest immediately, annual grants settle on the third anniversary of the grant date and initial grants settle upon separation from the board. In the nine months ended September 30, 2020, we granted an aggregate of 1,720,004 RSUs. Of these, 583,335 will vest and be settled ratably over a three‑year period from the grant date, 104,167 will vest and be settled ratably over a four‑year period from the grant date, 359,713 will vest and be settled ratably over 11 quarterly periods from the grant date and 13,805 will vest and be settled on the third anniversary of the grant date. In addition, we granted 475,422 performance‑based RSUs; the vesting of these RSUs is contingent on our achievement of specified performance goals for the years 2020 to 2022. Provided the goals are achieved, the performance‑based RSUs will vest and settle on the third anniversary of the grant date. The actual number of performance‑based RSUs that could vest will range from 0% to 200% of the 475,422 units granted, depending on our level of achievement with respect to the performance goals. We also granted 80,128 performance‑based RSUs to a Conifer senior officer, which were subsequently forfeited. In addition, in May 2020, we made an annual grant of 103,434 RSUs to our non‑employee directors for the 2020-2021 board service year, which units vested immediately and will settle in shares of our common stock on third anniversary of the date of the grant. The fair value of an RSU is based on our share price on the grant date. For certain of the performance‑based RSU grants, the number of units that will ultimately vest is subject to adjustment based on the achievement of a market‑based condition. The fair value of these RSUs is estimated through the use of a Monte Carlo simulation. Significant inputs used in our valuation of these RSUs included the following:
At September 30, 2021, there were $56 million of total unrecognized compensation costs related to RSUs. These costs are expected to be recognized over a weighted average period of 1.9 years. USPI Management Equity Plan USPI maintains a separate management equity plan under which it grants RSUs representing a contractual right to receive one share of USPI’s non‑voting common stock in the future. Once the requisite holding period is met, during specified times (“Repurchase Periods”), the participant can sell the underlying shares to USPI at their estimated fair market value. At our sole discretion, the purchase of any non‑voting common shares can be made in cash or in shares of Tenet’s common stock. The following table summarizes RSU activity under USPI’s management equity plan during the nine months ended September 30, 2021:
In the nine months ended September 30, 2021, we granted 76,990 RSUs under USPI’s management equity plan. Twenty percent of these RSUs vests on each of the first and second anniversaries of the grant date, and the remaining 60% vests on the third anniversary of the grant date. RSUs granted in 2020 vest 20% in each of the first three years on the anniversary of the grant date with the remaining 40% vesting on the fourth anniversary of the grant date. The first Repurchase Period opened in August 2021 and will close in November 2021. In the three months ended September 30, 2021, USPI paid $4.6 million to repurchase a portion of the non‑voting common stock issued under the USPI management equity plan. No shares were repurchased through the issuance of Tenet common stock during the three months ended September 30, 2021. Employee Retirement Plans In the nine months ended September 30, 2021 and 2020, we recognized (i) service cost related to one of our frozen non‑qualified defined benefit pension plans of less than $1 million for both periods in salaries, wages and benefits expense, and (ii) other components of net periodic pension cost (benefit) and net periodic postretirement benefit cost (benefit) related to our frozen qualified and non‑qualified defined benefit plans of $(4) million and $6 million, respectively, in other non-operating income, net, in the accompanying Condensed Consolidated Statements of Operations.
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EQUITY |
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EQUITY | EQUITY Changes in Shareholders’ Equity The following tables show the changes in consolidated equity during the nine months ended September 30, 2021 and 2020 (dollars in millions, share amounts in thousands):
Our noncontrolling interests balances at September 30, 2021 and December 31, 2020 were comprised of $130 million and $116 million, respectively, from our Hospital Operations segment, and $783 million and $793 million, respectively, from our Ambulatory Care segment. Our net income available to noncontrolling interests for the nine months ended September 30, 2021 and 2020 in the table above were comprised of $16 million and $9 million, respectively, from our Hospital Operations segment, and $142 million and $106 million, respectively, from our Ambulatory Care segment.
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NET OPERATING REVENUES |
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Revenue from Contract with Customer [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
NET OPERATING REVENUES | CONTRACT BALANCES Hospital Operations Segment Amounts related to services provided to patients for which we have not billed and that do not meet the conditions of unconditional right to payment at the end of the reporting period are contract assets. For our Hospital Operations segment, our contract assets include services that we have provided to patients who are still receiving inpatient care in our facilities at the end of the reporting period. Our Hospital Operations segment’s contract assets were included in other current assets in the accompanying Condensed Consolidated Balance Sheets at September 30, 2021 and December 31, 2020. Approximately 91% of our Hospital Operations segment’s contract assets meet the conditions for unconditional right to payment and are reclassified to patient receivables within 90 days. In certain circumstances, when a hospital is experiencing financial difficulty due to delays in receiving payment for the Medicare services it provided, it may be eligible for an accelerated or advance payment pursuant to the Medicare accelerated payment program. As discussed in Note 1, the COVID Acts revised the Medicare accelerated payment program in an attempt to disburse payments to hospitals more quickly. During the year ended December 31, 2020, our Hospital Operations segment received advance payments from the Medicare accelerated payment program following its expansion under the COVID Acts. These advance payments were recorded as contract liabilities in the accompanying Condensed Consolidated Balance Sheets at September 30, 2021 and December 31, 2020. No additional advances were received in the three and nine months ended September 30, 2021. The opening and closing balances of contract assets and contract liabilities for our Hospital Operations segment are as follows:
During the three and nine months ended September 30, 2021, $161 million and $302 million, respectively, of Medicare advance payments included in the opening contract liabilities balance for our Hospital Operations segment were recouped through a reduction of our Medicare claims payments. Ambulatory Care Segment During the year ended December 31, 2020, our Ambulatory Care segment also received advance payments from the expanded Medicare accelerated payment program. At September 30, 2021, contract liabilities in the accompanying Condensed Consolidated Balance Sheet included $78 million of Medicare advance payments received by our unconsolidated affiliates for whom we provide cash management services. At December 31, 2020, contract liabilities and contract liabilities – long‑term in the accompanying Condensed Consolidated Balance Sheet included $51 million and $62 million, respectively, of Medicare advance payments received by our unconsolidated affiliates for whom we provide cash management services. The opening and closing balances of contract liabilities for our Ambulatory Care segment are as follows:
During the three and nine months ended September 30, 2021, $13 million and $24 million, respectively, of Medicare advance payments included in the opening contract liabilities balance for our Ambulatory Care segment were recouped through a reduction of our Medicare claims payments. Additionally, $14 million and $26 million of Medicare advances received by our unconsolidated affiliates for whom we provide cash management services included in the opening contract liabilities balance were recouped during the three and nine months ended September 30, 2021, respectively. Conifer Segment Conifer enters into contracts with customers to provide revenue cycle management and other services, such as value‑based care, consulting and project services. The payment terms and conditions in our customer contracts vary. In some cases, customers are invoiced in advance and (for other than fixed‑price fee arrangements) a true‑up to the actual fee is included on a subsequent invoice. In other cases, payment is due in arrears. In addition, some contracts contain performance incentives, penalties and other forms of variable consideration. When the timing of Conifer’s delivery of services is different from the timing of payments made by the customers, Conifer recognizes either unbilled revenue (performance precedes contractual right to invoice the customer) or deferred revenue (customer payment precedes Conifer service performance). In the following table, customers that prepay prior to obtaining control/benefit of the service are represented by deferred contract revenue until the performance obligations are satisfied. Unbilled revenue represents arrangements in which Conifer has provided services to and the customer has obtained control/benefit of services prior to the contractual invoice date. Contracts with payment in arrears are recognized as receivables in the month the service is performed. The opening and closing balances of Conifer’s receivables, contract assets and contract liabilities are as follows:
The difference between the opening and closing balances of Conifer’s contract assets and contract liabilities are primarily related to prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are typically not distinct and are, therefore, recognized over the performance obligation period to which they relate. Our Conifer segment’s receivables and contract assets were reported as part of other current assets in our accompanying Condensed Consolidated Balance Sheets, and its current and long‑term contract liabilities were reported as part of contract liabilities and contract liabilities – long‑term, respectively, in our accompanying Condensed Consolidated Balance Sheets. In the nine months ended September 30, 2021 and 2020, Conifer recognized $56 million and $61 million, respectively, of revenue that was included in the opening current deferred revenue liability. This revenue consists primarily of prepayments for those customers who are billed in advance, changes in estimates related to metric‑based services, and up‑front integration services that are recognized over the services period. Contract Costs During the three months ended September 30, 2021 and 2020, we recognized amortization expense related to deferred contract setup costs of $1 million and $2 million, respectively. In the nine months ended September 30, 2021 and 2020, we recognized amortization expense related to deferred contract setup costs of $3 million and $4 million, respectively. At September 30, 2021 and December 31, 2020, the unamortized customer contract costs were $23 million and $24 million, respectively, and are presented as part of investments and other assets in the accompanying Condensed Consolidated Balance Sheets. NET OPERATING REVENUESNet operating revenues for our Hospital Operations and Ambulatory Care segments primarily consist of net patient service revenues, principally for patients covered by Medicare, Medicaid, managed care and other health plans, as well as certain uninsured patients under our Compact with Uninsured Patients and other uninsured discount and charity programs. Net operating revenues for our Conifer segment primarily consist of revenues from providing revenue cycle management services to health systems, as well as individual hospitals, physician practices, self‑insured organizations, health plans and other entities.The table below shows our sources of net operating revenues less implicit price concessions from continuing operations:
Adjustments for prior‑year cost reports and related valuation allowances, principally related to Medicare and Medicaid, increased revenues in the nine months ended September 30, 2021 and 2020 by $21 million and $3 million, respectively. Estimated cost report settlements and valuation allowances were included in accounts receivable in the accompanying Condensed Consolidated Balance Sheets (see Note 2). We believe that we have made adequate provision for any adjustments that may result from final determination of amounts earned under all the above arrangements with Medicare and Medicaid. The table below shows the composition of net operating revenues for our Ambulatory Care segment:
The table below shows the composition of net operating revenues for our Conifer segment:
Other services represented approximately 8% and 7% of Conifer’s revenue for the nine months ended September 30, 2021 and 2020, respectively, and include value‑based care services, consulting services and other client‑defined projects. Performance Obligations The following table includes Conifer’s revenue that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, performance incentives, penalties or other variable consideration that is considered constrained. Conifer’s contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032.
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PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE |
9 Months Ended |
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Sep. 30, 2021 | |
Property and Professional and General Liablity Insurance [Abstract] | |
PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE | PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE Property Insurance We have property, business interruption and related insurance coverage to mitigate the financial impact of catastrophic events or perils that is subject to deductible provisions based on the terms of the policies. These policies are on an occurrence basis. For the policy period April 1, 2021 through March 31, 2022, we have coverage totaling $850 million per occurrence, after deductibles and exclusions, with annual aggregate sub‑limits of $100 million for floods, $200 million for earthquakes and a per‑occurrence sub‑limit of $200 million for named windstorms with no annual aggregate. With respect to fires and other perils, excluding floods, earthquakes and named windstorms, the total $850 million limit of coverage per occurrence applies. Deductibles are 5% of insured values up to a maximum of $40 million for California earthquakes, $25 million for floods and named windstorms, and 2% of insured values for New Madrid fault earthquakes, with a maximum per claim deductible of $25 million. Floods and certain other covered losses, including fires and other perils, have a minimum deductible of $1 million. Professional and General Liability Reserves We are self‑insured for the majority of our professional and general liability claims and purchase insurance from third‑parties to cover catastrophic claims. At September 30, 2021 and December 31, 2020, the aggregate current and long‑term professional and general liability reserves in the accompanying Condensed Consolidated Balance Sheets were $1.030 billion and $978 million, respectively. These reserves include the reserves recorded by our captive insurance subsidiaries and our self‑insured retention reserves recorded based on modeled estimates for the portion of our professional and general liability risks, including incurred but not reported claims, for which we do not have insurance coverage. If the aggregate limit of any of our professional and general liability policies is exhausted, in whole or in part, it could deplete or reduce the limits available to pay any other material claims applicable to that policy period. Malpractice expense of $269 million and $233 million was included in other operating expenses, net, in the accompanying Condensed Consolidated Statements of Operations for the nine months ended September 30, 2021 and 2020, respectively.
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CLAIMS AND LAWSUITS |
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Commitments and Contingencies Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CLAIMS AND LAWSUITS | CLAIMS AND LAWSUITS We operate in a highly regulated and litigious industry. Healthcare companies are subject to numerous investigations by various governmental agencies. Further, private parties have the right to bring qui tam or “whistleblower” lawsuits against companies that allegedly submit false claims for payments to, or improperly retain overpayments from, the government and, in some states, private payers. We and our subsidiaries have received inquiries in recent years from government agencies, and we may receive similar inquiries in future periods. We are also subject to class action lawsuits, employment‑related claims and other legal actions in the ordinary course of business. Some of these actions may involve large demands, as well as substantial defense costs. We cannot predict the outcome of current or future legal actions against us or the effect that judgments or settlements in such matters may have on us. We record accruals for estimated losses relating to claims and lawsuits when available information indicates that a loss is probable and we can reasonably estimate the amount of the loss or a range of loss. Significant judgment is required in both the determination of the probability of a loss and the determination as to whether a loss is reasonably estimable. These determinations are updated at least quarterly and are adjusted to reflect the effects of negotiations, settlements, rulings, advice of legal counsel and technical experts, and other information and events pertaining to a particular matter, but are subject to significant uncertainty regarding numerous factors that could affect the ultimate loss levels. If a loss on a material matter is reasonably possible and estimable, we disclose an estimate of the loss or a range of loss. In cases where we have not disclosed an estimate, we have concluded that the loss is either not reasonably possible or the loss, or a range of loss, is not reasonably estimable, based on available information. Given the inherent uncertainties associated with these matters, especially those involving governmental agencies, and the indeterminate damages sought in some cases, there is significant uncertainty as to the ultimate liability we may incur from these matters, and an adverse outcome in one or more of these matters could be material to our results of operations or cash flows for any particular reporting period. Government Investigation of Detroit Medical Center Detroit Medical Center (“DMC”) is subject to an ongoing investigation commenced in October 2017 by the U.S. Attorney’s Office for the Eastern District of Michigan and the Civil Division of the U.S. Department of Justice (“DOJ”) for potential violations of the Stark law, the Medicare and Medicaid anti‑kickback and anti‑fraud and abuse amendments codified under Section 1128B(b) of the Social Security Act, and the federal False Claims Act related to DMC’s employment of nurse practitioners and physician assistants (“Mid‑Level Practitioners”) from 2006 through 2017. As previously disclosed, a media report was published in August 2017 alleging that 14 Mid‑Level Practitioners were terminated by DMC earlier in 2017 due to compliance concerns. On September 28, 2021, the DOJ issued a civil investigative demand to DMC for documents and interrogatories. We are cooperating with the investigation; however, we are unable to determine the potential exposure, if any, at this time. Other Matters In July 2019, certain of the entities that purchased from us the operations of Hahnemann University Hospital and St. Christopher’s Hospital for Children in Philadelphia commenced Chapter 11 bankruptcy proceedings. As previously disclosed in our Form 8‑K filed September 1, 2017, the purchasers assumed our funding obligations under the Pension Fund for Hospital and Health Care Employees of Philadelphia and Vicinity (the “Fund”), a pension plan related to the operations at Hahnemann University Hospital. Pursuant to rules under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), under certain circumstances we could become liable for withdrawal liability in the event a withdrawal is triggered with respect to the Fund. In addition, pursuant to applicable ERISA rules, we could become secondarily liable if the purchasers fail to satisfy their obligations to the Fund. We are also subject to claims and lawsuits arising in the ordinary course of business, including potential claims related to, among other things, the care and treatment provided at our hospitals and outpatient facilities, the application of various federal and state labor laws, tax audits and other matters. Although the results of these claims and lawsuits cannot be predicted with certainty, we believe that the ultimate resolution of these ordinary course claims and lawsuits will not have a material effect on our business or financial condition. New claims or inquiries may be initiated against us from time to time, including lawsuits from patients, employees and others exposed to COVID‑19 at our facilities. These matters could (1) require us to pay substantial damages or amounts in judgments or settlements, which, individually or in the aggregate, could exceed amounts, if any, that may be recovered under our insurance policies where coverage applies and is available, (2) cause us to incur substantial expenses, (3) require significant time and attention from our management, and (4) cause us to close or sell hospitals or otherwise modify the way we conduct business. The following table presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs recorded in continuing operations during the nine months ended September 30, 2021 and 2020.
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REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES |
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Noncontrolling Interest [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES | REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIESWe have a put call agreement (the “Baylor Put/Call Agreement”) with Baylor University Medical Center (“Baylor”) that contains put and call options with respect to the 5% ownership interest Baylor holds in USPI. Each year starting in 2021, Baylor may put up to one‑third of their total shares in USPI held as of April 1, 2017 by delivering notice by the end of January of such year. In each year that Baylor does not put the full 33.3% of USPI’s shares allowable, we may call the difference between the number of shares Baylor put and the maximum number of shares they could have put that year. In addition, the Baylor Put/Call Agreement contains a call option pursuant to which we have the ability to acquire all of Baylor’s ownership interest by 2024. We have the ability to choose whether to settle the purchase price for the Baylor put/call, which is mutually agreed‑upon fair market value, in cash or shares of our common stock. Baylor did not deliver a put notice to us in January 2021. In February 2021, we notified Baylor of our intention to exercise our call option to purchase 33.3% of the USPI shares held by Baylor as of April 1, 2017. Based on the nature of the Baylor Put/Call Agreement, Baylor’s minority interest in USPI was classified as a redeemable noncontrolling interest in the accompanying Condensed Consolidated Balance Sheets at September 30, 2021 and December 31, 2020. The following table shows the changes in redeemable noncontrolling interests in equity of consolidated subsidiaries during the nine months ended September 30, 2021 and 2020:
The following tables show the composition by segment of our redeemable noncontrolling interests balances at September 30, 2021 and December 31, 2020, as well as our net income available to redeemable noncontrolling interests for the nine months ended September 30, 2021 and 2020:
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INCOME TAXES |
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Income Tax Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
INCOME TAXES | INCOME TAXESDuring the three months ended September 30, 2021, we recorded income tax expense of $197 million in continuing operations on pre-tax income of $774 million compared to an income tax benefit of $197 million on a pre-tax loss of $304 million during the three months ended September 30, 2020. During the nine months ended September 30, 2021, we recorded income tax expense of $303 million in continuing operations on pre-tax income of $1.360 billion compared to an income tax benefit of $227 million on a pre-tax loss of $5 million during the nine months ended September 30, 2020. For the nine months ended September 30, 2021, the provision for income taxes was calculated by applying an estimate of the annual effective tax rate for the full year to “ordinary” income or loss (pre‑tax income or loss excluding unusual or infrequently occurring discrete items) for the reporting period. In calculating “ordinary” income, non‑taxable income or loss attributable to noncontrolling interests was deducted from pre-tax income or loss in the determination of the annualized effective tax rate used to calculate income taxes for the quarter. For the nine months ended September 30, 2020, we utilized the discrete effective tax rate method, as allowed by the Financial Accounting Standards Board Accounting Standards Codification 740‑270‑30‑18, “Income Taxes–Interim Reporting,” to calculate the interim income tax provision. The discrete method is applied when application of the estimated annual effective tax rate is impractical because it is not possible to reliably estimate the annual effective tax rate. The discrete method treats the year‑to‑date period as if it were the annual period and determines the income tax expense or benefit on that basis. We believe that the use of this discrete method in 2020 was more appropriate than the annual effective tax rate method as the estimated annual effective tax rate method was not reliable due to the high degree of uncertainty in estimating annual pre‑tax income due to the impact of the COVID‑19 pandemic and the evolving guidance by the government on utilization of grant funds. The reconciliation between the amount of recorded income tax expense (benefit) and the amount calculated at the statutory federal tax rate is shown in the following table:
As a result of the change in the business interest expense disallowance rules under the COVID Acts, we recorded an income tax benefit of $88 million during the nine months ended September 30, 2020 to decrease the valuation allowance for interest expense carryforwards due to the additional deduction of interest expense. During the nine months ended September 30, 2021, there were no adjustments to our estimated liabilities for uncertain tax positions. The total amount of unrecognized tax benefits at September 30, 2021 was $31 million, of which $29 million, if recognized, would impact our effective tax rate and income tax expense (benefit) from continuing operations. Our practice is to recognize interest and penalties related to income tax matters in income tax expense in our statement of operations. There were no accrued interest and penalties on unrecognized tax benefits at September 30, 2021. At September 30, 2021, no significant changes in unrecognized federal and state tax benefits were expected in the next 12 months as a result of the settlement of audits, the filing of amended tax returns or the expiration of statutes of limitations.
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EARNINGS (LOSS) PER COMMON SHARE |
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Earnings Per Share [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
EARNINGS (LOSS) PER COMMON SHARE | EARNINGS (LOSS) PER COMMON SHARE The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings (loss) per common share calculations for our continuing operations for three and nine months ended September 30, 2021 and 2020. Net income available (loss attributable) to our common shareholders is expressed in millions and weighted average shares are expressed in thousands.
All potentially dilutive securities were excluded from the calculation of diluted loss per share for the three and nine months ended September 30, 2020 because we did not report income from continuing operations available to common shareholders in those periods. In circumstances where we do not have income from continuing operations available to common shareholders, the effect of stock options and other potentially dilutive securities is anti‑dilutive; that is, a loss from continuing operations attributable to common shareholders has the effect of making the diluted loss per share less than the basic loss per share. Had we generated income from continuing operations available to common shareholders in the three and nine months ended September 30, 2020, the effect (in thousands) of employee stock options, restricted stock units and deferred compensation units on the diluted shares calculation would have been an increase in shares of 1,240 and 1,135 in the three and nine months ended September 30, 2020, respectively.
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FAIR VALUE MEASUREMENTS |
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Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
FAIR VALUE MEASUREMENTS | FAIR VALUE MEASUREMENTS Fair Value Measurements We are required to provide additional disclosures about fair value measurements as part of our financial statements for each major category of assets and liabilities measured at fair value. In general, fair values determined by Level 1 inputs utilize quoted prices (unadjusted) in active markets for identical assets or liabilities, which generally are not applicable to non‑financial assets and liabilities. Fair values determined by Level 2 inputs utilize data points that are observable, such as definitive sales agreements, appraisals or established market values of comparable assets. Fair values determined by Level 3 inputs are unobservable data points for the asset or liability and include situations where there is little, if any, market activity for the asset or liability, such as internal estimates of future cash flows. Our non‑financial assets and liabilities not permitted or required to be measured at fair value on a recurring basis typically relate to long‑lived assets held and used, long‑lived assets held for sale and goodwill. The following table presents information about assets measured at fair value at December 31, 2020 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values. There were no assets measured at fair value on a non‑recurring basis at September 30, 2021.
Financial Instruments The fair value of our long‑term debt (except for borrowings under the Credit Agreement) is based on quoted market prices (Level 1). The inputs used to establish the fair value of the borrowings outstanding under the Credit Agreement are considered to be Level 2 inputs, which include inputs other than quoted prices included in Level 1 that are observable, either directly or indirectly. At September 30, 2021 and December 31, 2020, the estimated fair value of our long‑term debt was approximately 104.2% and 104.5%, respectively, of the carrying value of the debt.
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ACQUISITIONS |
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Business Combination and Asset Acquisition [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ACQUISITIONS | ACQUISITIONS Preliminary purchase price allocations (representing the fair value of the consideration conveyed) for all acquisitions made during the nine months ended September 30, 2021 and 2020 are as follows:
The goodwill generated from these transactions, the majority of which will be deductible for income tax purposes, can be attributed to the benefits that we expect to realize from operating efficiencies and growth strategies. The goodwill total of $65 million from acquisitions completed during the nine months ended September 30, 2021 was recorded in our Ambulatory Care segment. Approximately $6 million and $3 million in transaction costs related to prospective and closed acquisitions were expensed during the nine‑month periods ended September 30, 2021 and 2020, respectively, and were included in impairment and restructuring charges, and acquisition‑related costs in the accompanying Condensed Consolidated Statements of Operations. We are required to allocate the purchase prices of acquired businesses to assets acquired or liabilities assumed and, if applicable, noncontrolling interests based on their fair values. The excess of the purchase price allocated over those fair values is recorded as goodwill. We are in the process of assessing working capital balances as well as obtaining and evaluating valuations of the acquired property and equipment, management contracts and other intangible assets, and noncontrolling interests for some of our 2021 and 2020 acquisitions. Therefore, those purchase price allocations, including goodwill, recorded in the accompanying Condensed Consolidated Financial Statements are subject to adjustment once the assessments and valuation work are completed and evaluated. Such adjustments are recorded as soon as practical within the measurement period as defined by the accounting literature.
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SEGMENT INFORMATION |
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
SEGMENT INFORMATION | SEGMENT INFORMATION Our business consists of our Hospital Operations segment, our Ambulatory Care segment and our Conifer segment. The factors for determining the reportable segments include the manner in which management evaluates operating performance combined with the nature of the individual business activities. Our Hospital Operations segment is comprised of acute care and specialty hospitals, ancillary outpatient facilities, micro‑hospitals, imaging centers, physician practices, and other care sites and clinics. At September 30, 2021, our subsidiaries operated 60 hospitals serving primarily urban and suburban communities in nine states. On April 1, 2021, we transferred 24 imaging centers from our Ambulatory Care segment to our Hospital Operations segment. The total assets associated with the imaging centers transferred to our Hospital Operations segment constituted less than 1% of our consolidated total assets at March 31, 2021. In April 2021, we also completed the sale of the majority of the urgent care centers held by our Hospital Operations segment to an unaffiliated urgent care provider. In addition, we completed the sale of five Miami‑area hospitals and certain related operations in August 2021. Certain of the facilities in our Hospital Operations segment were classified as held for sale in the accompanying Condensed Consolidated Balance Sheet at December 31, 2020. Our Ambulatory Care segment is comprised of the operations of USPI. At September 30, 2021, USPI had interests in 318 ambulatory surgery centers (227 consolidated) and 24 surgical hospitals (five consolidated) in 31 states. At December 31, 2020, our Ambulatory Care segment included 40 urgent care centers that were classified as held for sale. We completed the divestiture of these urgent care centers in April 2021. At September 30, 2021, we owned approximately 95% of USPI. Our Conifer segment provides revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients. At September 30, 2021, Conifer provided services to approximately 650 Tenet and non‑Tenet hospitals and other clients nationwide. In 2012, we entered into an agreement documenting the terms and conditions of various services Conifer provides to Tenet hospitals (“RCM Agreement”), as well as an agreement documenting certain administrative services our Hospital Operations segment provides to Conifer. In March 2021, we entered into a month‑to‑month agreement amending the RCM Agreement effective January 1, 2021 (“Amended RCM Agreement”) to update certain terms and conditions related to the revenue cycle management services Conifer provides to Tenet hospitals. We believe the pricing terms for the services provided under the Amended RCM Agreement are commercially reasonable and consistent with estimated third‑party terms. At September 30, 2021, we owned approximately 76% of Conifer Health Solutions, LLC, which is Conifer’s principal subsidiary. The following tables include amounts for each of our reportable segments and the reconciling items necessary to agree to amounts reported in the accompanying Condensed Consolidated Balance Sheets and Condensed Consolidated Statements of Operations, as applicable:
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BASIS OF PRESENTATION (Policies) |
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Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Description of Business and Basis of Presentation | Description of Business and Basis of Presentation Tenet Healthcare Corporation (together with our subsidiaries, referred to herein as “Tenet,” “we,” “our” or “us”) is a diversified healthcare services company headquartered in Dallas, Texas. Through an expansive care network that includes USPI Holding Company, Inc. (“USPI”), at September 30, 2021 we operated 60 hospitals and approximately 460 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, imaging centers, and other care sites and clinics. We also operate Conifer Health Solutions, LLC through our Conifer Holdings, Inc. (“Conifer”) subsidiary, which provides revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients. This quarterly report supplements our Annual Report on Form 10‑K for the year ended December 31, 2020 (“Annual Report”). As permitted by the Securities and Exchange Commission for interim reporting, we have omitted certain notes and disclosures that substantially duplicate those in our Annual Report. For further information, refer to the audited Consolidated Financial Statements and notes included in our Annual Report. Unless otherwise indicated, all financial and statistical data included in these notes to our Condensed Consolidated Financial Statements relate to our continuing operations, with dollar amounts expressed in millions (except per‑share amounts). Although the Condensed Consolidated Financial Statements and related notes within this document are unaudited, we believe all adjustments considered necessary for a fair presentation have been included and are of a normal recurring nature. In preparing our financial statements in conformity with accounting principles generally accepted in the United States (“GAAP”), we are required to make estimates and assumptions that affect the amounts reported in our Condensed Consolidated Financial Statements and these accompanying notes. We regularly evaluate the accounting policies and estimates we use. In general, we base the estimates on historical experience and on assumptions that we believe to be reasonable given the particular circumstances in which we operate. Actual results may vary from those estimates. Financial and statistical information we report to other regulatory agencies may be prepared on a basis other than GAAP or using different assumptions or reporting periods and, therefore, may vary from amounts presented herein. Although we make every effort to ensure that the information we report to those agencies is accurate, complete and consistent with applicable reporting guidelines, we cannot be responsible for the accuracy of the information they make available to the public. Operating results for the three and nine‑month periods ended September 30, 2021 are not necessarily indicative of the results that may be expected for the full year. Reasons for this include, but are not limited to: the impact of the COVID‑19 pandemic on our operations, business, financial condition and cash flows; the impact of the demand for, and availability of, qualified medical personnel on compensation costs; overall revenue and cost trends, particularly the timing and magnitude of price changes; fluctuations in contractual allowances and cost report settlements and valuation allowances; managed care contract negotiations, settlements or terminations and payer consolidations; trends in patient accounts receivable collectability and associated implicit price concessions; fluctuations in interest rates; levels of malpractice insurance expense and settlement trends; impairment of long‑lived assets and goodwill; restructuring charges; losses, costs and insurance recoveries related to natural disasters and other weather‑related occurrences; litigation and investigation costs; acquisitions and dispositions of facilities and other assets; gains (losses) on sales, consolidation and deconsolidation of facilities; income tax rates and deferred tax asset valuation allowance activity; changes in estimates of accruals for annual incentive compensation; the timing and amounts of stock option and restricted stock unit grants to employees and directors; gains (losses) from early extinguishment of debt; and changes in occupancy levels and patient volumes. Factors that affect service mix, revenue mix, patient volumes and, thereby, the results of operations at our hospitals and related healthcare facilities include, but are not limited to: changes in federal, state and local healthcare and business regulations, including mandated closures and other operating restrictions; the business environment, economic conditions and demographics of local communities in which we operate; the number of uninsured and underinsured individuals in local communities treated at our hospitals; disease hotspots and seasonal cycles of illness; climate and weather conditions; physician recruitment, satisfaction, retention and attrition; advances in technology and treatments that reduce length of stay; local healthcare competitors; utilization pressure by managed care organizations, as well as managed care contract negotiations or terminations; hospital performance data on quality measures and patient satisfaction, as well as standard charges for services; any unfavorable publicity about us, or our joint venture partners, that impacts our relationships with physicians and patients; and changing consumer behavior, including with respect to the timing of elective procedures. These considerations apply to year‑to‑year comparisons as well. Certain prior‑year amounts have been reclassified to conform to the current year presentation. In the accompanying Condensed Consolidated Balance Sheets, income tax receivable has been reclassified to other current assets, as it is no longer significant enough to present separately. In the accompanying Condensed Consolidated Statements of Cash Flows, long‑term assets has been combined with other items, net, as it is no longer significant enough to present separately, but it remains located within cash flows from investing activities.
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Cash and Cash Equivalents | Cash and Cash Equivalents We treat highly liquid investments with original maturities of three months or less as cash equivalents. Cash and cash equivalents were $2.292 billion and $2.446 billion at September 30, 2021 and December 31, 2020, respectively. At September 30, 2021 and December 31, 2020, our book overdrafts were $155 million and $154 million, respectively, which were classified as accounts payable. At September 30, 2021 and December 31, 2020, $169 million and $166 million, respectively, of total cash and cash equivalents in the accompanying Condensed Consolidated Balance Sheets were intended for the operations of our captive insurance subsidiaries. Also at September 30, 2021 and December 31, 2020, we had $51 million and $93 million, respectively, of property and equipment purchases accrued for items received but not yet paid. Of these amounts, $45 million and $85 million, respectively, were included in accounts payable. During the nine months ended September 30, 2021 and 2020, we recorded right‑of‑use assets related to non‑cancellable finance leases of $81 million and $75 million, respectively, and related to non‑cancellable operating leases of $121 million and $135 million, respectively.
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Investments in Unconsolidated Affiliates | Investments in Unconsolidated AffiliatesWe control 232 of the facilities within our Ambulatory Care segment and, therefore, consolidate their results. We account for many of the facilities our Ambulatory Care segment operates (110 of 342 at September 30, 2021), as well as additional companies in which our Hospital Operations segment holds ownership interests, under the equity method as investments in unconsolidated affiliates and report only our share of net income as equity in earnings of unconsolidated affiliates in the accompanying Condensed Consolidated Statements of Operations. |
BASIS OF PRESENTATION (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of other intangible assets | The following tables provide information regarding other intangible assets, which were included in the accompanying Condensed Consolidated Balance Sheets at September 30, 2021 and December 31, 2020:
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Schedule of estimated future amortization of intangibles with finite useful lives | Estimated future amortization of intangibles with finite useful lives at September 30, 2021 is as follows:
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Schedule of equity method investments | Summarized financial information for these equity method investees is included in the following table. For investments acquired during the reported periods, amounts reflect 100% of the investee’s results beginning on the date of our acquisition of the investment.
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ACCOUNTS RECEIVABLE (Tables) |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Accounts Receivable Additional Disclosures [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of components of accounts receivable | The principal components of accounts receivable are shown in the table below:
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Schedule of location of assets and liabilities | The following table summarizes the amount and classification of assets and liabilities in the accompanying Condensed Consolidated Balance Sheets related to California’s provider fee program at September 30, 2021 and December 31, 2020:
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Schedule of estimated costs for charity care and self-pay patients | The following table shows our estimated costs (based on selected operating expenses, which include salaries, wages and benefits, supplies and other operating expenses) of caring for our uninsured and charity patients in the three and nine months ended September 30, 2021 and 2020:
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CONTRACT BALANCES (Tables) |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Revenue from Contract with Customer [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of opening and closing balances of Company's contract assets | The opening and closing balances of contract assets and contract liabilities for our Hospital Operations segment are as follows:
The opening and closing balances of contract liabilities for our Ambulatory Care segment are as follows:
The opening and closing balances of Conifer’s receivables, contract assets and contract liabilities are as follows:
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ASSETS AND LIABILITIES HELD FOR SALE (Tables) |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discontinued Operation, Additional Disclosures [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Assets and liabilities classified as held for sale and summary of disposals of significant business components | The table below provides information on significant components of our business that have been recently disposed of:
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LONG-TERM DEBT (Tables) |
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Long-term Debt and Lease Obligation [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of long-term debt | The table below shows our long‑term debt at September 30, 2021 and December 31, 2020:
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EMPLOYEE BENEFIT PLANS (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Share-based Payment Arrangement [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of stock option activity | The following table summarizes stock option activity during the nine months ended September 30, 2021:
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Summary of information about stock options by range of exercise prices | The following table summarizes information about our outstanding stock options at September 30, 2021:
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Summary of restricted stock unit activity | The following table summarizes activity with respect to restricted stock units (“RSUs”) during the nine months ended September 30, 2021:
The following table summarizes RSU activity under USPI’s management equity plan during the nine months ended September 30, 2021:
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Schedule of assumptions used to determine fair value of stock options | Significant inputs used in our valuation of these RSUs included the following:
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EQUITY (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stockholders' Equity Note [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of changes in consolidated equity | The following tables show the changes in consolidated equity during the nine months ended September 30, 2021 and 2020 (dollars in millions, share amounts in thousands):
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NET OPERATING REVENUES (Tables) |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Revenue from Contract with Customer [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Disaggregation of operating revenues less provision for doubtful accounts and implicit price concessions | The table below shows our sources of net operating revenues less implicit price concessions from continuing operations:
The table below shows the composition of net operating revenues for our Ambulatory Care segment:
The table below shows the composition of net operating revenues for our Conifer segment:
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Performance obligation, expected timing of satisfaction | The following table includes Conifer’s revenue that is expected to be recognized in the future related to performance obligations that are unsatisfied, or partially unsatisfied, at the end of the reporting period. The amounts in the table primarily consist of revenue cycle management fixed fees, which are typically recognized ratably as the performance obligation is satisfied. The estimated revenue does not include volume‑ or contingency‑based contracts, performance incentives, penalties or other variable consideration that is considered constrained. Conifer’s contract with Catholic Health Initiatives (“CHI”), a minority interest owner of Conifer Health Solutions, LLC, represents the majority of the fixed‑fee revenue related to remaining performance obligations. Conifer’s contract term with CHI ends December 31, 2032.
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CLAIMS AND LAWSUITS (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Commitments and Contingencies Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reconciliations of legal settlements and related costs | The following table presents reconciliations of the beginning and ending liability balances in connection with legal settlements and related costs recorded in continuing operations during the nine months ended September 30, 2021 and 2020.
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REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Noncontrolling Interest [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of changes in redeemable noncontrolling interests in equity of consolidated subsidiaries | The following table shows the changes in redeemable noncontrolling interests in equity of consolidated subsidiaries during the nine months ended September 30, 2021 and 2020:
The following tables show the composition by segment of our redeemable noncontrolling interests balances at September 30, 2021 and December 31, 2020, as well as our net income available to redeemable noncontrolling interests for the nine months ended September 30, 2021 and 2020:
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INCOME TAXES (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Income Tax Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of reconciliation between reported income tax expense (benefit) and income taxes calculated by the statutory federal income tax rate | The reconciliation between the amount of recorded income tax expense (benefit) and the amount calculated at the statutory federal tax rate is shown in the following table:
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EARNINGS (LOSS) PER COMMON SHARE (Tables) |
9 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2021 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Earnings Per Share [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of reconciliation of numerators and denominators of our basic and diluted loss per common share | The following table is a reconciliation of the numerators and denominators of our basic and diluted earnings (loss) per common share calculations for our continuing operations for three and nine months ended September 30, 2021 and 2020. Net income available (loss attributable) to our common shareholders is expressed in millions and weighted average shares are expressed in thousands.
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FAIR VALUE MEASUREMENTS (Tables) |
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Sep. 30, 2021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of fair value assets on a nonrecurring basis | The following table presents information about assets measured at fair value at December 31, 2020 and indicates the fair value hierarchy of the valuation techniques we utilized to determine such fair values. There were no assets measured at fair value on a non‑recurring basis at September 30, 2021.
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ACQUISITIONS (Tables) |
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Sep. 30, 2021 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Business Combination and Asset Acquisition [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of preliminary purchase price allocation | Preliminary purchase price allocations (representing the fair value of the consideration conveyed) for all acquisitions made during the nine months ended September 30, 2021 and 2020 are as follows:
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SEGMENT INFORMATION (Tables) |
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reconciliation of assets by reportable segment to consolidated assets | The following tables include amounts for each of our reportable segments and the reconciling items necessary to agree to amounts reported in the accompanying Condensed Consolidated Balance Sheets and Condensed Consolidated Statements of Operations, as applicable:
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Reconciliation of other significant reconciling items from segments to consolidated |
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BASIS OF PRESENTATION - Description of Business and Basis of Presentation (Details) |
9 Months Ended |
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Sep. 30, 2021
outpatientCenter
hospital
| |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Number of hospitals operated by subsidiaries | hospital | 60 |
Number of healthcare facilities | outpatientCenter | 460 |
BASIS OF PRESENTATION - Cash and Cash Equivalents (Details) - USD ($) $ in Millions |
9 Months Ended | 12 Months Ended | |
---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Dec. 31, 2020 |
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Cash and Cash Equivalents | |||
Cash and cash equivalents | $ 2,292 | $ 2,446 | |
Accrued property and equipment purchases for items received but not yet paid | 51 | 93 | |
Non-cancellable finance leases entered into | 81 | $ 75 | |
Non-cancellable operating leases liability entered into | 121 | $ 135 | |
Captive Insurance Subsidiaries | |||
Cash and Cash Equivalents | |||
Cash and cash equivalents | 169 | 166 | |
Accounts Payable | |||
Cash and Cash Equivalents | |||
Book overdrafts classified as accounts payable | 155 | 154 | |
Accrued property and equipment purchases for items received but not yet paid | $ 45 | $ 85 |
BASIS OF PRESENTATION - Other Intangible Assets (Details) - USD ($) $ in Millions |
Sep. 30, 2021 |
Dec. 31, 2020 |
---|---|---|
Other intangible assets | ||
Gross Carrying Amount | $ 2,806 | $ 2,884 |
Accumulated Amortization | (1,326) | (1,284) |
Net Book Value | 1,480 | 1,600 |
Capitalized software costs | ||
Other intangible assets | ||
Gross Carrying Amount | 1,732 | 1,800 |
Accumulated Amortization | (1,123) | (1,084) |
Net Book Value | 609 | 716 |
Trade names | ||
Other intangible assets | ||
Gross Carrying Amount | 102 | 102 |
Accumulated Amortization | 0 | 0 |
Net Book Value | 102 | 102 |
Contracts | ||
Other intangible assets | ||
Gross Carrying Amount | 870 | 872 |
Accumulated Amortization | (124) | (111) |
Net Book Value | 746 | 761 |
Other | ||
Other intangible assets | ||
Gross Carrying Amount | 102 | 110 |
Accumulated Amortization | (79) | (89) |
Net Book Value | $ 23 | $ 21 |
BASIS OF PRESENTATION - Amortization of Intangible Assets (Details) - USD ($) $ in Millions |
9 Months Ended | |
---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Amortization of intangible assets | ||
Total | $ 796 | |
2021 | 53 | |
2022 | 124 | |
2023 | 110 | |
2024 | 98 | |
2025 | 83 | |
Later Years | 328 | |
Amortization expense | $ 139 | $ 127 |
ACCOUNTS RECEIVABLE - Components (Details) - USD ($) $ in Millions |
Sep. 30, 2021 |
Dec. 31, 2020 |
---|---|---|
Accounts receivable and allowance for doubtful accounts | ||
Accounts receivable, net | $ 2,742 | $ 2,690 |
Continuing Operations | ||
Accounts receivable and allowance for doubtful accounts | ||
Patient accounts receivable | 2,558 | 2,499 |
Estimated future recoveries | 139 | 156 |
Net cost reports and settlements receivable and valuation allowances | 44 | 34 |
Accounts receivable, net | 2,741 | 2,689 |
Discontinued operations | ||
Accounts receivable and allowance for doubtful accounts | ||
Accounts receivable, net | $ 1 | $ 1 |
ACCOUNTS RECEIVABLE - Location of Assets and Liabilities (Details) - USD ($) $ in Millions |
Sep. 30, 2021 |
Dec. 31, 2020 |
---|---|---|
ASSETS | ||
Other current assets | $ 2,742 | $ 2,690 |
Liabilities: | ||
Other current liabilities | 1,100 | 1,207 |
California's Provider Fee Program | Other Current Assets | ||
ASSETS | ||
Other current assets | 257 | 378 |
California's Provider Fee Program | Other Assets | ||
ASSETS | ||
Investments and other assets | 318 | 206 |
California's Provider Fee Program | Other Current Liabilities | ||
Liabilities: | ||
Other current liabilities | 93 | 110 |
California's Provider Fee Program | Other Long-term Liabilities | ||
Liabilities: | ||
Other long-term liabilities | $ 98 | $ 56 |
ACCOUNTS RECEIVABLE - Allowance (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Accounts receivable and allowance for doubtful accounts | ||||
Estimated costs of caring | $ 206 | $ 195 | $ 581 | $ 579 |
Uninsured patients | ||||
Accounts receivable and allowance for doubtful accounts | ||||
Estimated costs of caring | 181 | 165 | 507 | 466 |
Charity care patients | ||||
Accounts receivable and allowance for doubtful accounts | ||||
Estimated costs of caring | $ 25 | $ 30 | $ 74 | $ 113 |
CONTRACT BALANCES - Ambulatory Care Segment (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | |||
---|---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2021 |
Dec. 31, 2020 |
Sep. 30, 2020 |
Dec. 31, 2019 |
|
Disaggregation of Revenue [Line Items] | |||||
Contract liabilities | $ 1,218 | $ 1,218 | $ 659 | ||
Contract liabilities – long-term | 15 | 15 | 918 | ||
Ambulatory Care | |||||
Disaggregation of Revenue [Line Items] | |||||
Contract liabilities | 113 | 113 | 93 | $ 172 | $ 0 |
Contract liabilities – long-term | 0 | 0 | 83 | $ 0 | $ 0 |
Contract liabilities advance payments | 13 | 24 | |||
Equity Method Investment, Nonconsolidated Investee or Group of Investees | Ambulatory Care | |||||
Disaggregation of Revenue [Line Items] | |||||
Contract liabilities | 78 | 78 | 51 | ||
Contract liabilities – long-term | $ 62 | ||||
Contract liabilities advance payments | $ 14 | $ 26 |
CONTRACT BALANCES - Contract Costs (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | |||
---|---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
Dec. 31, 2020 |
|
Revenue from Contract with Customer [Abstract] | |||||
Amortization expense | $ 1 | $ 2 | $ 3 | $ 4 | |
Unamortized contract cost | $ 23 | $ 23 | $ 24 |
ASSETS AND LIABILITIES HELD FOR SALE - Narrative (Details) $ in Millions |
1 Months Ended | 3 Months Ended | |
---|---|---|---|
Aug. 31, 2021
hospital
|
Sep. 30, 2021
USD ($)
|
Jun. 30, 2021
USD ($)
|
|
Miami-Area Hospitals | |||
Current Assets and Liabilities Held for Sale | |||
Number of hospitals for sale | hospital | 5 | ||
Gain on sale of properties | $ (409) | ||
Urgent Care Centers | |||
Current Assets and Liabilities Held for Sale | |||
Gain on sale of properties | $ 14 | ||
Philadelphia Building | |||
Current Assets and Liabilities Held for Sale | |||
Gain on sale of properties | $ 2 |
ASSETS AND LIABILITIES HELD FOR SALE - Significant Disposals (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||
Income from continuing operations, before income taxes | $ 407 | $ 6 | $ 436 | $ 21 |
Miami area | ||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||
Income from continuing operations, before income taxes | $ 407 | $ 6 | $ 436 | $ 21 |
EMPLOYEE BENEFIT PLANS - Narrative (Details) - USD ($) $ in Millions |
9 Months Ended | |
---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Share-based Payment Arrangement [Abstract] | ||
Stock-based compensation costs, pretax | $ 43 | $ 38 |
EMPLOYEE BENEFIT PLANS - Valuation of Restricted Stock Units (Details) - Restricted Stock Units |
9 Months Ended | |
---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Expected volatility | 54.70% | |
Risk-free interest rate | 1.20% | |
Minimum | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Expected volatility | 65.20% | |
Risk-free interest rate | 0.10% | |
Maximum | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Expected volatility | 79.30% | |
Risk-free interest rate | 0.60% |
EMPLOYEE BENEFIT PLANS - Employee Retirement Plans (Details) $ in Millions |
3 Months Ended | 9 Months Ended | |
---|---|---|---|
Sep. 30, 2021
USD ($)
|
Sep. 30, 2021
USD ($)
plan
|
Sep. 30, 2020
USD ($)
|
|
Employee Retirement Plans | |||
Number of frozen plans | plan | 1 | ||
Salaries, Wages and Benefits Expense | |||
Employee Retirement Plans | |||
Service costs (less than in current year) | $ 1 | ||
Other Non-operating Income (Expense), Net | |||
Employee Retirement Plans | |||
Other components | $ (4) | $ 6 |
EQUITY - Narrative (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Sep. 30, 2021 |
Jun. 30, 2021 |
Mar. 31, 2021 |
Sep. 30, 2020 |
Jun. 30, 2020 |
Mar. 31, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
Dec. 31, 2020 |
Dec. 31, 2019 |
|
Accumulated Other Comprehensive Income (Loss) [Line Items] | ||||||||||
Stockholders equity balance | $ 1,635 | $ 1,169 | $ 1,016 | $ 522 | $ 633 | $ 503 | $ 1,635 | $ 522 | $ 937 | $ 437 |
Net income | 505 | 177 | 141 | (148) | 123 | 125 | ||||
Noncontrolling Interests | ||||||||||
Accumulated Other Comprehensive Income (Loss) [Line Items] | ||||||||||
Stockholders equity balance | 913 | 908 | 893 | 896 | 890 | 861 | 913 | 896 | 909 | $ 854 |
Net income | 56 | $ 58 | $ 44 | $ 48 | $ 35 | $ 32 | ||||
Noncontrolling Interests | Hospital Operations | ||||||||||
Accumulated Other Comprehensive Income (Loss) [Line Items] | ||||||||||
Stockholders equity balance | 130 | 130 | 116 | |||||||
Net income | 16 | 9 | ||||||||
Noncontrolling Interests | Ambulatory Care | ||||||||||
Accumulated Other Comprehensive Income (Loss) [Line Items] | ||||||||||
Stockholders equity balance | $ 783 | 783 | $ 793 | |||||||
Net income | $ 142 | $ 106 |
NET OPERATING REVENUES - Ambulatory Care (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | $ 4,894 | $ 4,557 | $ 14,629 | $ 12,725 |
Ambulatory Care | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | 666 | 565 | 1,976 | 1,423 |
Ambulatory Care | Net patient service revenues | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | 633 | 532 | 1,890 | 1,345 |
Ambulatory Care | Management fees | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | 21 | 23 | 64 | 60 |
Ambulatory Care | Revenue from other sources | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | $ 12 | $ 10 | $ 22 | $ 18 |
NET OPERATING REVENUES - Conifer (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | $ 4,894 | $ 4,557 | $ 14,629 | $ 12,725 |
Conifer | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | 314 | 325 | 943 | 962 |
Conifer | Revenue Cycle Services | Tenet | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | 112 | 132 | 350 | 375 |
Conifer | Revenue Cycle Services | Non-Tenet | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | 178 | 170 | 522 | 518 |
Conifer | Other Services | Tenet | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | 4 | 4 | 12 | 10 |
Conifer | Other Services | Non-Tenet | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues | $ 20 | $ 19 | $ 59 | $ 59 |
Conifer | Revenue from other sources | ||||
Disaggregation of Revenue [Line Items] | ||||
Net operating revenues, percentage of total | 8.00% | 7.00% |
PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE - Property Insurance (Details) - Scenario, Forecast $ in Millions |
12 Months Ended |
---|---|
Mar. 31, 2022
USD ($)
| |
Insurance coverage | |
Property insurance, annual coverage limit | $ 850 |
Floods | |
Insurance coverage | |
Property insurance, maximum coverage per incident | 100 |
Earthquake | |
Insurance coverage | |
Property insurance, maximum coverage per incident | 200 |
Property insurance, deductible | 40 |
Windstorms | |
Insurance coverage | |
Property insurance, maximum coverage per incident | 200 |
Fire and other perils | |
Insurance coverage | |
Property insurance, maximum coverage per incident | $ 850 |
Flood, earthquake and windstorm | |
Insurance coverage | |
Insurance deductible as a percent | 5.00% |
Flood and windstorm | |
Insurance coverage | |
Property insurance, deductible | $ 25 |
New Madrid Fault Earthquakes | |
Insurance coverage | |
Insurance deductible as a percent | 2.00% |
Property insurance, deductible | $ 25 |
Other Catastrophic Events | |
Insurance coverage | |
Property insurance, deductible | $ 1 |
PROPERTY AND PROFESSIONAL AND GENERAL LIABILITY INSURANCE - Professional and General Liability Reserves (Details) - USD ($) $ in Millions |
9 Months Ended | ||
---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Dec. 31, 2020 |
|
Other Operating Expense, Net | |||
Insurance coverage | |||
Malpractice expense | $ 269 | $ 233 | |
Professional and General Liability Reserves | |||
Insurance coverage | |||
Self insurance reserve | $ 1,030 | $ 978 |
CLAIMS AND LAWSUITS - Reconciliations (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Loss Contingency Accrual [Roll Forward] | ||||
Litigation reserve, balance at beginning of period | $ 26 | $ 86 | ||
Litigation and investigation costs | $ 29 | $ 9 | 64 | 13 |
Cash Payments | (44) | (84) | ||
Other | (5) | 0 | ||
Litigation reserve, balance at end of period | $ 41 | $ 15 | $ 41 | $ 15 |
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Narrative (Details) - United Surgical Partners International - Baylor University Medical Center |
Sep. 30, 2021 |
Apr. 01, 2017 |
---|---|---|
Put Option | ||
Redeemable Noncontrolling Interest [Line Items] | ||
Ownership percentage | 5.00% | |
Put Option | Maximum | ||
Redeemable Noncontrolling Interest [Line Items] | ||
Purchasable equity In joint venture, percentage of total shares (percentage) | 0.333 | 0.3333 |
Call Option | Maximum | ||
Redeemable Noncontrolling Interest [Line Items] | ||
Purchasable equity In joint venture, percentage of total shares (percentage) | 0.333 |
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Changes in Redeemable Noncontrolling Interests (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||||||
---|---|---|---|---|---|---|---|---|
Sep. 30, 2021 |
Jun. 30, 2021 |
Mar. 31, 2021 |
Sep. 30, 2020 |
Jun. 30, 2020 |
Mar. 31, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Increase (Decrease) in Temporary Equity [Roll Forward] | ||||||||
Distributions paid to noncontrolling interests | $ (51) | $ (43) | $ (61) | $ (46) | $ (8) | $ (40) | ||
Redeemable Noncontrolling Interests | ||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | ||||||||
Balances at beginning of period | $ 1,952 | $ 1,506 | $ 1,952 | $ 1,506 | ||||
Net income | 234 | 122 | ||||||
Distributions paid to noncontrolling interests | (161) | (90) | ||||||
Accretion of redeemable noncontrolling interests | 11 | 4 | ||||||
Purchases (sales) of businesses and noncontrolling interests, net | 12 | (63) | ||||||
Balances at end of period | $ 2,048 | $ 1,479 | $ 2,048 | $ 1,479 |
REDEEMABLE NONCONTROLLING INTERESTS IN EQUITY OF CONSOLIDATED SUBSIDIARIES - Segment Details (Details) - Redeemable Noncontrolling Interests - USD ($) $ in Millions |
9 Months Ended | |||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Dec. 31, 2020 |
Dec. 31, 2019 |
|
Redeemable Noncontrolling Interest [Line Items] | ||||
Redeemable noncontrolling interests | $ 2,048 | $ 1,479 | $ 1,952 | $ 1,506 |
Net income available to redeemable noncontrolling interests | 234 | 122 | ||
Hospital Operations | ||||
Redeemable Noncontrolling Interest [Line Items] | ||||
Redeemable noncontrolling interests | 292 | 267 | ||
Net income available to redeemable noncontrolling interests | 18 | (17) | ||
Ambulatory Care | ||||
Redeemable Noncontrolling Interest [Line Items] | ||||
Redeemable noncontrolling interests | 1,292 | 1,273 | ||
Net income available to redeemable noncontrolling interests | 164 | 94 | ||
Conifer | ||||
Redeemable Noncontrolling Interest [Line Items] | ||||
Redeemable noncontrolling interests | 464 | $ 412 | ||
Net income available to redeemable noncontrolling interests | $ 52 | $ 45 |
INCOME TAXES - Narrative (Details) - USD ($) |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Income Taxes | ||||
Income tax benefit (expense) | $ (197,000,000) | $ 197,000,000 | $ (303,000,000) | $ 227,000,000 |
Continued operations pre-tax earnings | 774,000,000 | (304,000,000) | 1,360,000,000 | (5,000,000) |
Current income tax benefit | 88,000,000 | |||
Increase (decrease) in estimated liabilities for uncertain tax positions, net of related deferred tax effects | 0 | |||
Unrecognized tax benefits | 31,000,000 | 31,000,000 | ||
Unrecognized tax benefits which, if recognized, would impact effective tax rate | 29,000,000 | 29,000,000 | ||
Interest and penalties related to accrued liabilities for uncertain tax positions, recognized | 0 | 0 | ||
Unrecognized federal and state tax benefits and reserves for interest and penalties, which may decrease in the next 12 months | 0 | 0 | ||
Continuing Operations | ||||
Income Taxes | ||||
Income tax benefit (expense) | $ (197,000,000) | $ 197,000,000 | $ (303,000,000) | $ 227,000,000 |
INCOME TAXES - Federal Tax Reconciliation (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Sep. 30, 2021 |
Sep. 30, 2020 |
|
Reconciliation between reported income tax expense (benefit) and income taxes calculated by the statutory federal income tax rate | ||||
Tax expense (benefit) at statutory federal rate of 21% | $ 163 | $ (64) | $ 286 | $ (1) |
State income taxes, net of federal income tax benefit | 29 | (6) | 56 | 9 |
Tax benefit attributable to noncontrolling interests | (26) | (18) | (79) | (48) |
Nondeductible goodwill | 28 | 0 | 35 | 0 |
Nontaxable gains | 0 | 0 | 0 | 3 |
Stock-based compensation | (1) | 1 | (4) | 1 |
Change in valuation allowance | 0 | (113) | 0 | (201) |
Other items | 4 | 3 | 9 | 10 |
Income tax expense (benefit) | $ 197 | $ (197) | $ 303 | $ (227) |
EARNINGS (LOSS) PER COMMON SHARE - Antidilutive securities (Details) - shares shares in Thousands |
3 Months Ended | 9 Months Ended |
---|---|---|
Sep. 30, 2020 |
Sep. 30, 2020 |
|
Employee stock options, restricted stock units and deferred compensation units | ||
Antidilutive securities | ||
Anti-dilutive securities excluded from computation of earnings per share (in shares) | 1,240 | 1,135 |
ACQUISITIONS - Preliminary purchase price allocations (Details) - USD ($) $ in Millions |
9 Months Ended | ||
---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Dec. 31, 2020 |
|
Final purchase price allocations | |||
Goodwill | $ 8,662 | $ 8,808 | |
Cash paid, net of cash acquired | (64) | $ (61) | |
Series of Individual Business Acquisitions | |||
Final purchase price allocations | |||
Current assets | 20 | 7 | |
Property and equipment | 26 | 15 | |
Other intangible assets | 1 | 8 | |
Goodwill | 65 | 78 | |
Other long-term assets, including previously held equity method investments | 8 | 6 | |
Current liabilities | (15) | (4) | |
Long-term liabilities | (10) | (6) | |
Redeemable noncontrolling interests in equity of consolidated subsidiaries | (28) | (30) | |
Noncontrolling interests | (2) | (13) | |
Cash paid, net of cash acquired | (64) | (61) | |
Gains on consolidations | $ 1 | $ 0 |
ACQUISITIONS - Narrative (Details) - USD ($) $ in Millions |
9 Months Ended | ||
---|---|---|---|
Sep. 30, 2021 |
Sep. 30, 2020 |
Dec. 31, 2020 |
|
Business Acquisition [Line Items] | |||
Goodwill | $ 8,662 | $ 8,808 | |
SurgeCenter Development | |||
Business Acquisition [Line Items] | |||
Goodwill | 65 | $ 78 | |
Transaction costs related to prospective and closed acquisitions | $ 6 | $ 3 |
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