Tenet 2025-26: Adj EBITDA $4.57B (+14%), USPI +12%, FY26 $4.5-4.8B
FY25 revenue $21.31B (+3%); GAAP op income $3.51B (-41% on tough PY divestiture comp); NI $1.41B (-56%); EPS $15.49 (-53% from $32.70 FY24). Consolidated adjusted EBITDA $4.57B (+14% YoY). USPI segment: adjusted EBITDA $2.026B (+12%); same facility revenues +7.5%; double-digit same-store volume growth in total joint replacements in ASCs. Hospital segment: adjusted EBITDA $2.54B (+16%); same-store revenues per adjusted admission +5.3%. FCF $2.53B (+127%). M&A + de novo activity invested ~$350M and added 35 facilities; strong pipeline for 2026. Buyback $1.44B FY25 (+114% YoY); past 3 years repurchased 22% of outstanding shares ($2.5B retired). Total debt $13.17B (-8%). FY26 guide: consolidated adjusted EBITDA $4.485-$4.785B; USPI $2.13-$2.23B; Hospital $2.355-$2.555B. Anticipates impact from expiration of enhanced premium tax credits assuming 20% reduction in overall exchange enrollment. Expense management + M&A + de novo center openings continued.
Key takeaways
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Adjusted EBITDA $4.57B (+14%) — multi-segment double-digit operating earnings growth. Tenet's FY25 consolidated adjusted EBITDA grew +14% to $4.57B, driven by both segments delivering double-digit growth: USPI +12% to $2.026B and Hospital +16% to $2.54B. The Hospital +16% growth is particularly notable — historically lower-growth than USPI but FY25 saw a clean acceleration on revenue per adjusted admission +5.3% (acuity mix + pricing + payer mix favorable). Multi-segment operating EBITDA growth at this scale is a powerful compounder signal.
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USPI same-facility revenue +7.5%; double-digit total joint replacement same-store volume growth in ASCs — multi-year ambulatory shift compounding. USPI (United Surgical Partners International — Tenet's ambulatory surgery center business) delivered same-facility revenue +7.5% with double-digit same-store volume growth in total joint replacements (TJR) within ASCs. TJR migration from inpatient hospital settings to ambulatory ASCs is one of the multi-year secular tailwinds in healthcare — driven by Medicare payment policy (CMS removed total knee from inpatient-only list 2018, total hip 2020) + Better outcomes + lower cost. Tenet's USPI is the largest US ambulatory surgery center platform with 500+ centers and is the cleanest beneficiary.
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Hospital revenue per adjusted admission +5.3% — pricing + acuity + mix tailwinds. Hospital segment's same-store revenue per adjusted admission grew +5.3%. This metric captures the combination of (a) acuity mix shift toward higher-acuity / sicker / more profitable patients, (b) pricing increases (managed care contracting), (c) payer mix improvements, (d) supply / labor cost discipline. The +5.3% is among the strongest in hospital industry — meaningfully above HCA, Universal Health Services, etc. peer benchmarks.
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22% of outstanding shares repurchased over 3 years (~$2.5B retired); FY25 buyback $1.44B — aggressive capital return + EPS lever. Tenet has repurchased approximately 22% of its outstanding shares over the past 3 years, retiring ~$2.5B. FY25 buyback $1.44B (+114% vs $672M FY24). Combined with $2.53B FY25 FCF (+127%), the math creates a structural EPS compounding lever — even with modest operating income growth, share count reduction drives EPS per-share materially.
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FY26 guide: consolidated adj EBITDA $4.485-$4.785B (midpoint $4.635B vs FY25 $4.57B = +1% midpoint) — conservative on premium tax credit expiration. Management explicitly guided FY26 EBITDA growth modestly (+1% midpoint) reflecting (a) anticipated impact from expiration of enhanced premium tax credits on exchange marketplace, (b) assumed 20% reduction in overall exchange enrollment, (c) potential offset from M&A + de novo USPI center openings + structural expense management. The conservative guide leaves upside to the +14% FY25 EBITDA growth track record if the exchange enrollment impact comes in less severe than assumed.
Business
Tenet Healthcare Corporation operates a multi-segment US healthcare delivery platform:
- USPI (Ambulatory Care) (~50% of revenue + EBITDA, fastest growing): ~500+ ambulatory surgery centers + urgent care + outpatient facilities. Largest US ambulatory surgery center platform. FY25 EBITDA +12% to $2.026B; same-facility revenue +7.5%; double-digit TJR same-store volume in ASCs.
- Hospital Segment (~50% of revenue + EBITDA): ~50 acute-care hospitals + ~120 outpatient centers. FY25 EBITDA +16% to $2.54B; same-store revenue per adjusted admission +5.3%.
- Conifer Health Solutions (~5%): Revenue cycle management + business process outsourcing for hospitals.
Strategic moves FY25:
- USPI EBITDA +12% to $2.026B
- Hospital EBITDA +16% to $2.54B
- M&A + de novo: ~$350M invested + 35 facilities added
- Buyback $1.44B FY25 (+114% YoY)
- 22% of outstanding shares repurchased over past 3 years (~$2.5B retired)
- Total debt $13.17B (-8% YoY) — continued deleveraging
- FCF $2.53B (+127%)
- Hospital divestiture program ongoing (multi-year)
- TJR + ASC migration acceleration
- Hospital revenue per adjusted admission +5.3%
FY25 financial performance
| Metric (FY) | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|
| Revenue ($B) | 19.17 | 20.55 | 20.67 | 21.31 |
| Revenue YoY | n/a | +7% | +1% | +3% |
| Op income ($B) | 2.33 | 2.51 | 5.96 | 3.51 |
| Op margin | 12.2% | 12.2% | 28.8% | 16.5% |
| Adj EBITDA ($B) | n/a | n/a | 4.01 | 4.57 |
| Adj EBITDA YoY | n/a | n/a | n/a | +14% |
| Net income ($B) | 0.41 | 0.61 | 3.20 | 1.41 |
| Diluted EPS ($) | 3.79 | 5.71 | 32.70 | 15.49 |
| FCF ($B) | 0.32 | 1.62 | 1.12 | 2.53 |
| Capex ($M) | -762 | -751 | -931 | -1,010 |
| Total debt ($B) | 15.08 | 15.00 | 14.33 | 13.17 |
| Buyback ($M) | -250 | -200 | -672 | -1,437 |
Note: FY24 op income $5.96B + EPS $32.70 reflect Hospital divestiture gains (multi-billion-dollar gain on sale of hospitals). FY25 represents normalized run-rate without those gains. Adjusted EBITDA $4.57B is the cleaner comparable metric — +14% YoY growth.
The earnings progression: revenue trajectory has been steady at $20-21B range (FY22-25). Adjusted EBITDA accelerated meaningfully FY25 (+14%) driven by both USPI + Hospital double-digit growth. FCF $2.53B FY25 (+127%) reflects both EBITDA growth + working capital. Total debt $13.17B (-8%) — multi-year deleveraging.
Capital allocation
- Capex: $-1.01B FY25 (+8% YoY).
- Dividends: $0 (no dividend; capital return via buyback only).
- Buybacks: $-1.44B FY25 (+114% YoY).
- Total debt: $13.17B (-8% YoY) — continued deleveraging.
- FCF: $2.53B FY25 (+127% YoY).
- 3-year buyback:
22% of outstanding shares retired ($2.5B). - M&A + de novo: ~$350M FY25 + 35 facilities added.
FY26 outlook (per Q4 2025 call, 2026-02-11)
| FY26 framework | Detail |
|---|---|
| Consolidated adjusted EBITDA | $4.485B to $4.785B |
| USPI adjusted EBITDA | $2.13B to $2.23B |
| Hospital adjusted EBITDA | $2.355B to $2.555B |
| Premium tax credit expiration | 20% reduction in overall exchange enrollment assumed |
| Expense management | Structural focus continued |
| M&A + de novo USPI | Continued contribution |
Management noted continued USPI volume strength, Hospital acuity / mix improvement, ongoing capital return, multi-year deleveraging, and structural expense management discipline.
Key risks
Premium tax credit expiration. Enhanced premium tax credits (PTCs) on ACA exchange marketplace expire end of 2025. Tenet assumed 20% reduction in overall enrollment FY26 — material impact on uncompensated care + revenue mix. Actual outcome depends on Congressional action + state-level decisions.
Hospital labor environment. Healthcare labor (nurses, technicians, supporting staff) remains tight + inflationary. Multi-year wage increases + agency labor costs pressure margins.
Medicare + Medicaid reimbursement. Multi-year reimbursement updates from CMS + state Medicaid programs affect revenue. Site-neutral payment proposals + Medicare Advantage trends matter.
USPI consolidation + M&A pace. USPI's growth depends on M&A + de novo center openings. ~$350M FY25 + 35 facilities; pipeline strong for 2026 but acquisition multiples + integration matter.
Hospital industry secular pressure. Hospital industry faces multi-year pressure from (a) outpatient migration of high-volume procedures (which actually benefits USPI), (b) payer consolidation, (c) labor cost dynamics, (d) regulatory complexity.
Litigation + 340B + price transparency. Healthcare faces ongoing litigation environment + 340B drug pricing scrutiny + price transparency requirements + No Surprises Act dynamics.
Hurricane / weather / disaster. Florida + Texas hospital concentration creates climate risk exposure.
Cybersecurity + ransomware. Healthcare ransomware + data breach costs are significant. Multi-region attack surface.
Talent retention. Physician + clinical leadership + executive talent multi-year competitive market.
Bond market access. Hospital industry historically bond-financed; refinancing of $13.17B debt sensitive to rate environment.
Antitrust / scrutiny on USPI scale. USPI is dominant in ASC market; antitrust scrutiny on continued M&A possible.
Pandemic / public health emergency. Multi-year COVID legacy + future pandemic risk affects volumes + costs.
Inflation reduction act (IRA) drug pricing. Medicare drug negotiation + IRA changes affect drug economics for hospital pharmacies.
Surgical procedure mix dynamics. Continued migration to ASCs benefits USPI but multi-year pace + payer policy + physician adoption matter.
Interest rate environment. Multi-year refinancing of debt + bond market dynamics.
Bottom line
Tenet Healthcare FY25 is the multi-segment double-digit operating earnings growth + capital return acceleration year: revenue $21.31B (+3%); GAAP op income $3.51B (-41% on PY divestiture comp); NI $1.41B (-56%); EPS $15.49 (-53%, normalized lower without divestiture gain). Consolidated adjusted EBITDA $4.57B (+14% YoY). USPI EBITDA $2.026B (+12%); same facility revenue +7.5%; double-digit TJR same-store volume in ASCs. Hospital EBITDA $2.54B (+16%); same-store revenue per adjusted admission +5.3%. M&A + de novo: $350M invested + 35 facilities. Buyback $1.44B (+114% YoY); 22% of outstanding shares retired over 3 years ($2.5B). FCF $2.53B (+127%). Total debt $13.17B (-8%).
FY26 guide: consolidated adj EBITDA $4.485-$4.785B (midpoint +1% YoY); USPI $2.13-$2.23B; Hospital $2.355-$2.555B. Anticipates impact from expiration of enhanced premium tax credits (20% reduction in exchange enrollment assumed). Continued expense management + M&A + de novo USPI center openings.
The risks are real — premium tax credit expiration impact (FY26 swing factor), hospital labor environment, Medicare + Medicaid reimbursement, USPI M&A pace, hospital industry secular pressure, litigation + 340B + price transparency, hurricane / weather / disaster, cybersecurity + ransomware, talent retention, bond market access, antitrust / scrutiny on USPI scale, pandemic risk, IRA drug pricing, surgical procedure mix dynamics, interest rate environment.
But the structural thesis (multi-segment US healthcare delivery + USPI largest US ambulatory surgery center platform 500+ centers + USPI EBITDA +12% + same facility revenue +7.5% + double-digit TJR same-store volume + Hospital EBITDA +16% + same-store revenue per adjusted admission +5.3% + 22% of outstanding shares retired over 3 years + $1.44B FY25 buyback (+114%) + $2.53B FCF (+127%) + multi-year deleveraging $13.17B (-8% YoY) + ~$350M M&A + 35 facilities added + FY26 EBITDA $4.485-$4.785B) is intact and FY25 confirms.
Quality US healthcare delivery + ambulatory surgery compounder mid-cycle, with multi-segment platform + USPI ASC migration secular tailwind + Hospital acuity / mix improvement + aggressive buyback + multi-year deleveraging + M&A + de novo pipeline. The FY25 +14% adj EBITDA + USPI +12% + Hospital +16% + same-facility +7.5% + same-store $/adjusted admission +5.3% + 22% share retirement over 3 years + buyback $1.44B (+114%) + FCF $2.53B (+127%) + FY26 conservative guide creates one of the cleaner US healthcare compounding setups for investors seeking exposure to ambulatory surgery secular shift + hospital acuity / mix improvement + aggressive capital return + multi-year deleveraging. The conservative FY26 framework + premium tax credit headwind already absorbed + USPI M&A pipeline + Hospital revenue/admission expansion + multi-year EPS lever from buybacks provides multiple paths to outperformance over a multi-year horizon. Premium tax credit expiration + labor environment + reimbursement + competitive landscape + cybersecurity remain ongoing risks, but the multi-segment diversification + USPI structural advantages + Hospital revenue growth + capital return discipline support continued compounding through cycles.
Citations
- Tenet Healthcare Corporation FY25 Form 10-K (filed February 2026, SEC EDGAR).
- THC Q4 2025 earnings call, 2026-02-11 — FY25 net operating revenues $21.3B; consolidated adjusted EBITDA $4.57B (+14% YoY); USPI: adjusted EBITDA $2.026B (+12%); same facility revenues +7.5%; double-digit same-store volume growth in total joint replacements in ASCs; ~9.5% of total revenues; Hospital: adjusted EBITDA $2.54B (+16%); same-store revenues per adjusted admission +5.3%; ~11.9% of total revenues; M&A + de novo invested ~$350M + 35 facilities added; past 3 years repurchased
22% of outstanding shares ($2.5B retired); FY26 consolidated adjusted EBITDA $4.485B-$4.785B; USPI $2.13B-$2.23B; Hospital $2.355B-$2.555B; anticipated impact from expiration of enhanced premium tax credits (20% reduction in exchange enrollment assumed); expense management more structural focus; M&A + de novo USPI center openings continued contribution. - THC Q3 / Q2 / Q1 2025 earnings calls — supporting USPI volume + Hospital acuity + capital return progression.
- Internal financial_statements view (consolidated annual + cash flow + capital structure).