Tenet Reports Results for the Fourth Quarter Ended December 31, 2016 and Issues Outlook for 2017

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- Tenet Healthcare Corporation (NYSE:THC) reported a net loss from continuing operations of $79 million in the fourth quarter of 2016, a $21 million improvement when compared to a $100 million net loss from continuing operations in the fourth quarter of 2015. Adjusted EBITDA was $613 million in both the fourth quarters of 2016 and 2015 (see also Tenet Healthcare Corporation).

Trevor Fetter, chairman and chief executive officer, stated, "Demand for higher acuity services in our hospitals drove growth in same-hospital patient revenue and revenue per adjusted admission in the fourth quarter. Our Ambulatory and Conifer Health businesses delivered strong revenue and Adjusted EBITDA growth. Our expectations for continued growth in 2017 reflect confidence in our strategy to strengthen our hospital portfolio, expand our network of ambulatory facilities, and solidify Conifer's leadership in healthcare business services." Hospital Operations and Other Segment Net operating revenue in the Hospital Operations and other segment was $4.143 billion, down 6.3 percent from $4.423 billion in the fourth quarter of 2015 due to hospitals that have been divested since that time. On a same-hospital basis, patient revenue increased to $3.782 billion, up 3.2 percent from $3.666 billion in the fourth quarter of 2015. The increase included growth of 3.7 percent in net patient revenue per adjusted admission, offset by a 0.5 percent decrease in adjusted patient admissions.

Adjusted EBITDA in Tenet's hospital segment was $358 million, representing a decline of 9.1 percent as compared to $394 million in the fourth quarter of 2015. The decline was driven by divestitures in 2015 and 2016 and an expected decrease in electronic health record incentives, and was partially offset by acquisitions in 2015.

Tenet's health plan business lowered Adjusted EBITDA by $29 million in the fourth quarter of 2016. For the full year, the health plan business lowered Adjusted EBITDA by $37 million, whereas the Company had anticipated at the outset of 2016 that the results for its health plans would be essentially breakeven. As previously announced, the Company has begun the process of selling or otherwise exiting its health plan business.

Total hospital segment selected operating expenses, defined as the sum of salaries, wages and benefits, supplies and other operating expenses, increased 2.8 percent on a per adjusted admission basis in the quarter. Approximately one-third of the increase was attributable to an increase in claim costs of Tenet's health plans due to an increase in covered lives in 2016. Exchanges Tenet's same-hospital exchange admissions were 4,916 in the fourth quarter of 2016, up 13.6 percent from the fourth quarter of 2015. Same-hospital exchange outpatient visits were 48,435 up 26.4 percent from the fourth quarter of 2015. Uncompensated Care Tenet's provision for doubtful accounts was $354 million in the fourth quarter of 2016, representing a ratio of 6.8 percent of revenues before bad debt, as compared to $391 million in the fourth quarter of 2015, or 7.2 percent of revenues before bad debt. Tenet's uncompensated care costs, defined as the sum of the provision for doubtful accounts, charity care write-offs and uninsured discounts, was $1.332 billion and $1.420 billion in the fourth quarters of 2016 and 2015, respectively, including $978 million and $1.029 billion, respectively, of charity care write-offs and uninsured discounts that were offered through Tenet's Compact with Uninsured Patients. Uncompensated care in the fourth quarter of 2016 represented 21.5 percent of revenue before bad debts, uninsured discounts and charity care write-offs, down from 22.0 percent in the fourth quarter of 2015. Nearly all of Tenet's uncompensated care is associated with the Hospital Operations and other segment.

Uninsured plus charity admissions increased by 444 admissions, or 4.9 percent on a same-hospital basis in the fourth quarter of 2016 compared to the fourth quarter of 2015. Uninsured plus charity outpatient visits decreased by 14,330 visits, or 11.4 percent, on a same-hospital basis. Ambulatory Care Segment During the fourth quarter of 2016, the Ambulatory segment produced net operating revenue of $478 million, representing an increase of 20.4 percent as compared to $397 million in the fourth quarter of 2015. In addition, the Ambulatory segment generated Adjusted EBITDA of $183 million, up 15.8 percent from $158 million in the fourth quarter of 2015.

The results of many of the facilities in which the Ambulatory segment has an investment are not consolidated by Tenet. To help analyze the segment's results of operations, management uses system-wide measures which include revenues and cases of both consolidated and unconsolidated facilities. On a same-facility system-wide basis, revenue in the Ambulatory segment increased 5.9 percent, with cases increasing 1.7 percent and revenue per case increasing 4.1 percent. One less surgical day lowered revenue growth and case growth in the Ambulatory segment by approximately 1.6 percent in the fourth quarter of 2016. Conifer Segment During the fourth quarter of 2016, Conifer's revenue increased 4.7 percent to $402 million, up from $384 million in the fourth quarter of 2015. Revenue from third party customers increased 16.0 percent to $239 million. Conifer generated $72 million of Adjusted EBITDA in the fourth quarter of 2016, up 18.0 percent from $61 million in the fourth quarter of 2015. Net Income and Earnings Per Share Tenet reported a net loss from continuing operations of $79 million, or $0.79 per share, in the fourth quarter of 2016 compared to a net loss of $100 million, or $1.01 per share, in the fourth quarter of 2015.

After adjusting for certain items which are listed on Table #2, Tenet generated Adjusted net income from continuing operations of $6 million, or $0.06 per diluted share, during the fourth quarter of 2016, as compared to Adjusted net income from continuing operations of $35 million, or $0.35 per diluted share, in the fourth quarter of 2015.

A reconciliation of GAAP net income available (loss attributable) to Tenet Healthcare Corporation common shareholders to Adjusted net income from continuing operations and Adjusted diluted earnings per share from continuing operations is contained in Table #2 at the end of this release. Cash Flow and Liquidity Cash and cash equivalents were $716 million at December 31, 2016 compared to $649 million at September 30, 2016. On December 1, 2016, the Company completed a private offering of $750 million aggregate principal amount senior secured second lien notes maturing in 2022 (the "notes"). The net proceeds of the notes were used, after payment of fees and expenses, to repay indebtedness outstanding under Tenet's senior secured revolving credit facility and for general corporate purposes. The Company had no outstanding borrowings on its $1 billion credit line as of December 31, 2016. Accounts receivable days outstanding were 54.8 at December 31, 2016 compared to 52.9 at September 30, 2016 and 49.5 at December 31, 2015.

Net cash provided by operating activities in the twelve months ended December 31, 2016 was $558 million, representing a $468 million decline compared to $1.026 billion in 2015. After subtracting $875 million and $842 million of capital expenditures in the twelve months ended December 31, 2016 and December 31, 2015, respectively, Free Cash Flow was an outflow of $317 million in the twelve months ended December 31, 2016, representing a $501 million decline compared to $184 million in the comparable period in 2015. This decline was primarily attributable to approximately $517 million of payments related to the resolution of the Clinica de la Mama matter, which were made in the fourth quarter of 2016. Adjusted Free Cash Flow was $380 million in the twelve months ended December 31, 2016, representing a $25 million decline from $405 million in the comparable period in 2015. Adjusted Free Cash Flow was below the Company's Outlook of $400 million to $600 million in 2016, primarily due to an unanticipated increase in accounts receivable days sales outstanding in the fourth quarter of 2016 and an $80 million delay by the State of California in processing Provider Fee program payments.

Net cash used in investing activities was $430 million in the twelve months ended December 31, 2016 compared to $1.317 billion of net cash used in investing activities in the comparable period in 2015. Net cash provided by financing activities was $232 million in the twelve months ended December 31, 2016 compared to $454 million of net cash provided by financing activities in the comparable period in 2015.

Keywords for this news article include: Finance, Hospital, Managed Care, Tenet Healthcare Corporation.

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