Record Financial Performance
Full-year 2025 revenue of $6.3 billion, up 6% year-over-year; adjusted EBITDA of $545 million, up 9% with margin expansion of 20 basis points to 8.6%; operating cash flow of $471 million in 2025, up 49% versus 2024; Q4 operating cash flow $223 million.
Raised IMPACT Program Target
IMPACT operating transformation program now expected to contribute approximately $55 million to adjusted EBITDA in 2026 (raised from $40 million); about $5 million of IMPACT savings recognized in 2025 with the rest ramping into 2026.
Labor and Staffing Improvements
Salaried wages & benefits declined 0.4% year-over-year in Q4; SWB (salaries, wages & benefits) per adjusted admission declined 2% in Q4 after earlier growth; contract labor expenses reduced 26% to $17 million in Q4 and now account for 2.6% of SWB (lowest since 2019); agency labor FTEs reduced by ~175 in last 4 months of 2025.
Strengthened Balance Sheet and Liquidity
Total cash increased by ~ $150 million to $710 million at year-end 2025; lease-adjusted net leverage reduced ~0.5x to 2.5x (from 2.9x); total net leverage 0.8x; total available liquidity approximately $1.0 billion; total debt outstanding $1.1 billion.
Q4 Operational Wins and Efficiency
Q4 adjusted EBITDA of $134 million was ~2% above guidance midpoint; first-case on-time starts in operating rooms improved by over 10 percentage points Q4 vs Q3; surgeries were essentially flat in Q4 while adjusted admissions grew ~2% (Q4) and full-year admissions growth was 5.3% with adjusted admissions growth 2.3% (full year).
Technology and AI-Driven Care Transformation
Enterprise AI and virtual care initiatives driving efficiency: AI scribe reduces physician documentation time by 35% and is used in ~85% of patient visits; planned AI-assisted virtual care expansion to span >2,000 patient rooms by year-end; medical wearables in implemented markets reduced mortality by up to 15% and shortened length of stay by ~1/3 day.
Disciplined 2026 Guidance
Issued 2026 adjusted EBITDA guidance of $485M-$535M (midpoint $510M) and revenue guidance of $6.4B-$6.7B (~3.6% growth at midpoint); management expects core earnings growth (~4%) plus IMPACT savings to offset known headwinds and anticipates EBITDA growth resuming in 2027.