Q1 Hospital Recap: Solid Vols Despite Tough
Flu Comp, Still Overall Results Mixed
■ Overall Results Mixed: Two of the four public hospital companies that we
cover reported EBITDA ahead of consensus expectations. HCA beat the
Street by a wide margin ($262 mln ahead, including an $86 mln payor
settlement award), while THC was ahead of the Street by $9 mln. UHS and
CYH both missed consensus expectations modestly.
■ Q1 Volumes Generally Strong Despite the Flu Comp: For the first
quarter of 2019, the hospital group reported SS inpatient admissions
growth of 1.5%, on average. This represents an increase in the Y/Y growth
rate of 110 bps sequentially and an increase of 130 bps Y/Y. UHS had the
strongest growth in SS admissions at 5.2%, followed by HCA at 0.9%. CYH
and THC both SS admissions down just 0.1%, a significant improvement
for both companies relative to the recent past. SS adjusted admissions
grew 2% for the group, on average, a sequential improvement of 110 bps
and a Y/Y improvement of 190 bps in the growth rate. UHS was strongest
on this metric as well at 4.9%, followed by HCA at 1.8%, CYH at 0.8%, and
THC at 0.6%. Each of the four companies said that a tough flu comp was a
headwind to volume growth on a Y/Y basis.
■ Q1 Pricing Metrics: On pricing, the group reported a Y/Y increase in net
revenue per adjusted admission of 1.9%, on average, in the first quarter of
2019. This represents a decrease in the Y/Y growth rate of 60 bps
sequentially and 200 bps relative to 1Q18. HCA had the strongest pricing
growth at 4.4% (3.6% ex- the settlement award), while UHS had a pricing
decline of 0.4%. UHS attributed the pricing weakness to a lower mix of
surgical services and a higher mix of medical cases.
■ Outlook for Remainder of Year: CYH, THC, and UHS maintained the key
figures in their 2019 guidance. HCA modestly increased its EBITDA
guidance to account for the $86 mln settlement award, which was not in
original guidance. HCA is tracking well ahead of expectations after Q1, so
we could see a positive guidance revision when the company reports Q2
results. For THC, operating trends are looking somewhat better. Conifer
profitability has improved, but focus remains on the company’s plan to
conduct a strategic transaction with respect to Conifer. We’ll look for UHS’
SS pricing to bounce back in Q2, and focus will stay on potential
improvement in the psych segment (which looked a bit better in 1Q19).
While CYH’s volumes have picked up, the main focus there continues to be
on the capital structure challenges and the divestiture program.
■ Updating Models: With this note, we are updating our CYH, THC, and
UHS models. Our THC target price is now $25 (prev $33), and our UHS
target price is now $150 (prev $152). Risks to our ratings and target prices
for all hospital companies include volume and pricing trends.