Dallas-based Tenet Healthcare’s revenue topped $21.3 billion in 2025 — with $16.1 billion coming from its hospital business and $5.2 billion from its ambulatory division — as the for-profit system continues its strong track record of revenue growth.
The financial results come at a pivotal point in Tenet’s transformation.
In January, Tenet entered into a $1.9 billion deal with Chicago-based CommonSpirit to regain full ownership of Conifer Health Solutions, its revenue cycle management subsidiary.
Tenet has also significantly reduced its hospital footprint in recent years — selling 14 hospitals in 2024 alone — and is investing at least $250 million a year to acquire ASCs under its outpatient subsidiary United Surgical Partners International.
The system now operates 49 acute care hospitals while USPI has grown to include 533 ASCs and 26 surgical hospitals across 37 states.
“We had an active year in the M&A and de novo activity lines as well, investing nearly $350 million in 2025 and adding 35 facilities to the portfolio,” Tenet Chair and CEO Saum Sutaria, MD, said Feb. 11 during the company’s fourth-quarter earnings call. “The pipeline for both M&A and de novo development remains strong as we look into 2026. We remain the preferred acquirer and developer of assets in this space.”
Tenet’s hospital segment saw adjusted EBITDA increase 16% year over year to $2.5 billion in 2025. Same-store revenue per adjusted admission rose 5.3%, as payer mix and acuity remained strong. The company continued reinvesting into the business to further its capabilities, stepping up growth capital in 2025, according to Dr. Sutaria.
“Our portfolio of businesses is now more predictable with consistently strong performance in both the hospital segment and USPI,” he said. “Our results represent a continuation of a multiyear track record of strong same-store revenue growth, improved margins and disciplined execution by our management team. We remain focused on driving further organic growth supplemented by accretive M&A at USPI.”
USPI continues to drive growth as more complex and high-acuity procedures shift to lower-cost outpatient settings. Over the next three years, CMS will also phase out the Medicare inpatient-only list, a move that is expected to rapidly accelerate the outpatient migration of complex procedures.
“We see this as a gradual tailwind for USPI that will play out over several years. In this first year, we see opportunities in areas such as high acuity spine and urology procedures,” Dr. Sutaria said. “We have detailed tactical plans to capitalize on the opportunity and are actively operationalizing our capabilities to serve patients in 2026. USPI continues to be a high-growth, capital-efficient business that delivers high returns on capital expenditures.”
When asked about what type of growth he sees as sustainable, Dr. Sutaria pointed to Tenet’s recent track record of acuity growth and net revenue per case growth ahead of broader market trends.
“Our margin expansion over the past, not just two years, but even beyond that in the hospital segment itself has been significant above and beyond the asset sales that we did, which obviously helped some of that margin improvement,” he said. “We said all along that we kept the markets where we felt like we had the best opportunities for growth and leadership.”
In 2024, Tenet sold six hospitals in South Carolina, three in California and five in Alabama. It now operates 49 hospitals in eight states, with its largest footprints in Texas, Florida and California, according to its website.
This year, Tenet projects a 20% reduction in ACA exchange enrollment, with the expiration of enhanced premium tax credits set to pressure hospital earnings and the company’s payer mix.
“Our plans reflect the headwind associated with the expiration of the enhanced premium tax credits on the exchange marketplace,” Dr. Sutaria said. “We continue to closely monitor enrollment levels as well as the potential off-ramps for individuals to obtain coverage through lower medal tier commercial plans or other options.”
Sun Park, executive vice president and CFO, said the expiration of ACA subsidies is expected to result in lower volume growth and a less favorable payer mix.
“We estimate that this represents a $250 million impact to our 2026 adjusted EBITDA, primarily in the hospital segment,” Mr. Park said. “There are a wide range of potential outcomes here, and we will continue to monitor enrollment levels and effectuation rates.”
Dr. Sutaria said Tenet is implementing cost-savings initiatives to mitigate the pressure and that the “significant margin improvements” achieved in recent years provide a strong foundation for growth.
In terms of capital deployment, executives said Tenet’s priorities remain unchanged.
“First, we will continue to prioritize capital investments to grow USPI through M&A … [and] we see a strong pipeline to support our $250 million annual target for USPI M&A in 2026,” Mr. Park said. “Second, we expect to continue investing in key hospital growth opportunities to fuel organic growth, including our focus on higher acuity service offerings. Third, we’ll continue to have a balanced approach to share repurchases and depending on market conditions and other investment opportunities. And finally, we will continue to evaluate opportunities to retire and/or refinance debt.”
Looking longer term, Dr. Sutaria said the company is preparing for big policy shifts — such as Medicaid cuts outlined in the One Big Beautiful Bill Act — and how they will affect operations in 2028 and beyond.
“Now is the time to take on the challenge of really being well prepared for that,” Dr. Sutaria said. “We understand what the core growth guidance is … [and] we think there’s a lot of work that’s going to be required to get there and creativity. But on the other hand, that’s exactly the work we should be doing given the platform that we’ve built. And so that’s what we’re going after.”
The one caveat he noted is that Tenet is not modeling its outlook with strict specificity for 2027 or 2028, as upcoming elections could reshape or mitigate certain reimbursement provisions included in the OBBBA.
Dr. Sutaria emphasized that Tenet has spent several years strengthening its operational foundation: improving reliability, accountability and efficiency as it streamlined its hospital portfolio and aligned its overhead structure accordingly. The company is now positioned to take the next step, particularly as it deploys AI and automation tools more broadly.
“Now with the advent of many of these technologies in AI and automation, [we have] the ability to actually begin to deploy those and see if we can drive the next level of improvement. We’re better set up for that now because we have more standard processes,” he said. “We have more standard workflows, … [and] have labor and supply standards that have been uniformly disseminated across the company. It’s much harder to do those things when every market is doing something very different versus having established those standards.”
