The big four for-profit hospital operators posted a common thread in their second-quarter 2026 results: softened outpatient and ASC volumes.
Tenet Healthcare and HCA Healthcare leaned on acuity mix and pricing to largely offset the fewer procedures, though pricing didn’t fully offset the softness at Community Health Systems, where net revenue per adjusted admission slipped.
Here’s how each company’s outpatient and ASC business performed.
Tenet Healthcare.
Dallas-based Tenet Healthcare’s ambulatory arm, USPI, remains the largest ASC operator among the group, with interests in 538 ASCs (405 consolidated) and 26 surgical hospitals (8 consolidated) across 37 states as of June 30. USPI posted net operating revenues of $1.39 billion, up 9.3% year over year, and adjusted EBITDA of $542 million, up 8.8%, though margin slipped slightly to 39% from 39.2%. Same-facility system-wide surgical cases fell 1.2%, but revenue per case rose 6.3%, which Tenet attributed to higher acuity and a more favorable service mix.
HCA Healthcare.
Nashville-based HCA’s outpatient surgery volumes declined 3.4% on a same-facility basis, alongside a 2.3% drop in inpatient surgeries, continuing a softening trend in elective procedures. The bright spot was the emergency department. ER visits rose 3.6% for the quarter. HCA’s ambulatory footprint remains the largest by location count in the group, at roughly 2,600 sites spanning ASCs, freestanding emergency rooms, urgent care centers and physician clinics across 19 states and the U.K. As at USPI, pricing offset volume softness with revenue per equivalent admission growing 6.4%.
Community Health Systems.
Franklin, Tenn.-based Community Health Systems saw the most pronounced shift in site of care. CEO Kevin Hammons said on the company’s earnings call that procedural softness is concentrated in elective specialties, citing orthopedics — “being the largest decline” — and cardiac surgery, which he said “is following the same path, though the underlying care is less discretionary.”
Mr. Hammons also said CHS is seeing bigger declines on the inpatient side while its surgery centers are picking up volume, though it’s “lower acuity surgeries and not the orthopedic and some of the cardiac procedures” the company would normally expect, a sign that some volume may be migrating to ASCs rather than disappearing outright. He also pointed to patients delaying follow-on procedures for economic reasons, tied to commercially insured patients’ copays and deductibles. Net revenue per adjusted admission slipped 0.5% for the quarter.
Universal Health Services.
UHS is the outlier of the group. It isn’t a major ASC operator, and its outpatient growth story this quarter centered on behavioral health rather than surgery. The company’s pending acquisition of virtual behavioral health platform Talkspace is intended to build what CEO Mark Miller called “the nation’s first end-to-end continuum of behavioral healthcare services,” spanning acute inpatient and residential care, in-person outpatient treatment, and national virtual services.
CFO Steve Filton said the deal “should help accelerate our growth in outpatient,” adding Talkspace’s network of more than 6,000 therapists to fill gaps in geographic access and follow-up care. UHS did not disclose specific outpatient surgical volume metrics for the quarter and continues to guide to moderated volume growth in behavioral health.
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