Earnings Call Transcript - THC Q3 2025

Operator, Operator

Good morning, and welcome to Tenet Healthcare's Third Quarter 2025 Earnings Conference Call. I will now hand the call over to Mr. Will McDowell, Vice President of Investor Relations. Mr. McDowell, please proceed.

William McDowell, Vice President of Investor Relations

Good morning, everyone, and thank you for joining today's call. I am Will McDowell, Vice President of Investor Relations. We're pleased to have you join us for a discussion of Tenet's third quarter 2025 results as well as a discussion of our financial outlook. Tenet senior management participating in today's call will be Dr. Saum Sutaria, Chairman and Chief Executive Officer; and Sun Park, Executive Vice President and Chief Financial Officer. Our webcast this morning includes a slide presentation, which has been posted to the Investor Relations section of our website, tenethealth.com. Listeners to this call are advised that certain statements made during our discussion today are forward-looking and represent management's expectations based on currently available information. Actual results and plans could differ materially. Tenet is under no obligation to update any forward-looking statements based on subsequent information. Investors should take note of the cautionary statement slide included in today's presentation as well as the risk factors discussed in our most recent Form 10-K and other filings with the Securities and Exchange Commission. And with that, I'll turn the call over to Saum.

Saum Sutaria, CEO

All right. Thank you, Will, and good morning, everyone. We had another quarter of strong performance where we exceeded our expectations for revenue, adjusted EBITDA, and margins. Third quarter 2025 net operating revenues were $5.3 billion, and consolidated adjusted EBITDA grew 12% over the third quarter 2024 to $1.1 billion. This represents an adjusted EBITDA margin of 20.8%, which is a 170 basis points improvement over the prior year, driven by our strong same-store growth and continued operating efficiency. USPI continues to excel, and we generated $492 million in adjusted EBITDA, which represents 12% growth year-over-year. Same-facility revenues grew by 8.3% in the third quarter, highlighted by 11% growth in total joint replacements in the ASCs over the prior year. Our M&A and de novo activity remain robust as we acquired 11 centers and opened 2 de novo centers in the quarter, including facilities specializing in high acuity procedures such as spine and orthopedics. We have already spent nearly $300 million on M&A in this space year-to-date and expect to continue adding additional centers in the fourth quarter. The M&A and de novo pipelines remain strong. Turning to our hospital segment. Adjusted EBITDA grew 13% to $607 million in the third quarter of 2025. Same-store hospital admissions, adjusted admissions were up 1.4% in the quarter. And third quarter 2025 revenue per adjusted admission was up 5.9% over the prior year as payer mix and acuity remains strong. In September, we opened our newest hospital facility in Port St. Lucie, Florida. This facility expands capacity in one of the fastest-growing areas in the country. The hospital will provide comprehensive emergency and specialty care and is focused on leveraging state-of-the-art technology, including robotics and advanced cardiac catheterization techniques. Turning to our full year guidance. At this point in the year, we are once again raising our full year 2025 adjusted EBITDA guidance to a range of $4.47 billion to $4.57 billion. Building upon our substantial post second quarter guidance increase, indicating the confidence we have in our business this year, we have now increased our adjusted EBITDA guidance by $445 million or 11% at the midpoint of the range from our initial guidance. Additionally, we are increasing our investments in capital expenditures in 2025 and now expect to invest $875 million to $975 million to fuel organic growth in the future, a $150 million increase at the midpoint over our prior expectations. In addition to this increased investment, we are also raising our expectations for full year 2025 free cash flow minus NCI to a range of $1.495 billion to $1.695 billion, an increase of $250 million at the midpoint from our previous guidance range. This increase is driven not only by the fundamental growth in adjusted EBITDA but also by the strong cash collection performance of Conifer. Let me turn to 2026 with a few points. Uncertainty about the enhanced premium tax subsidies and the impact on reimbursement and enrollment in the exchanges still exists. Approvals for various increases in state directed payment programs for 2026 are still pending. Currently, in our hospital segment planning process, we see healthy patient demand that would support same-store volume growth and a stable operating environment supported by disciplined cost controls in 2026. Our strategy, which is more focused on higher acuity services, has delivered a track record of improved margins and strong earnings growth over the past few years. The return on invested capital for this improved portfolio of hospital assets is such that we have confidently increased our CapEx per bed from prior levels to higher levels in both 2024 and 2025, and we should continue to see the benefits of that into 2026. At USPI, we expect same-store revenue growth in line with our long-term expectations, along with a continued focus on high acuity cases, operational efficiencies, and disciplined cost controls. Additionally, we expect further contributions from M&A and de novo development. I would note that USPI is less exposed to Medicaid and the exchanges and our ASCs are on freestanding rates. We will continue to operate and invest in this attractive segment. In summary, we continue to deliver our commitments for sustained growth, expanding margins, a delevered balance sheet, and improved free cash flow generation. Our strong execution is driving attractive EBITDA growth that we are converting into significant free cash flow and our transformed portfolio of businesses are well-positioned to drive sustained performance in the future. And with that, Sun will provide us a more detailed review of our financial results. Sun, over to you.

Sun Park, CFO

Thank you, Saum, and good morning, everyone. We delivered strong results in the third quarter 2025 with adjusted EBITDA above the high end of our guidance range, once again driven by strong same-store revenue growth, continued high patient acuity, favorable payer mix, and effective cost controls. We generated total net operating revenues of $5.3 billion and consolidated adjusted EBITDA of $1.1 billion, a 12.4% increase year-over-year. Our adjusted EBITDA margin in the quarter was 20.8%, a continuation of our improved margin performance over multiple quarters. I would now like to highlight some key items for both of our segments, beginning with USPI, which again delivered strong operating results. In the third quarter, USPI's adjusted EBITDA grew 12% over last year, with adjusted EBITDA margins at 38.6%. USPI delivered an 8.3% increase in same-facility system-wide revenues with net revenue per case up 6.1% and same-facility case volumes up 2.1%. Turning to our hospital segment, third quarter 2025 adjusted EBITDA was $607 million, with margins up 160 basis points over last year at 15.1%. Same-hospital inpatient adjusted admissions increased 1.4% and revenue per adjusted admissions grew 5.9%. Our consolidated salary, wages, and benefits was 41.7% of net revenues, a 160 basis point improvement from the prior year, and our contract labor expense was 1.9% of consolidated SWB expenses. These improvements continue to be driven by our data-driven approach to capacity and labor management and disciplined operating expense controls. Finally, we recognized a $38 million pretax impact for Medicaid supplemental revenues related to prior years in the third quarter of 2025. As a reminder, in total, year-to-date, we have recorded $148 million of favorable pretax impacts associated with Medicaid supplemental revenues related to prior years. Next, we will discuss our cash flow, balance sheet and capital structure. We generated $778 million of free cash flow in the third quarter, amounting to $2.16 billion of free cash flow year-to-date, which is up 22% over the same 9-month period in the prior year. As of September 30, 2025, we had $2.98 billion of cash on hand with no borrowings outstanding under our line of credit facility. Additionally, we have no significant debt maturities until 2027. And finally, during the third quarter, we repurchased 598,000 shares of our stock for $93 million. Year-to-date through September 30, we have repurchased 7.8 million shares for $1.2 billion. Our leverage ratio as of September 30 was 2.3x EBITDA or 2.93x EBITDA less NCI, driven by our outstanding operational performance and continued focus on financial discipline. We believe we have significant financial flexibility to support our capital allocation priorities and drive shareholder value and are very pleased with our ongoing cash flow generation capabilities. We remain committed to a deleveraged balance sheet. Let me now turn to our outlook for 2025. For '25, we now expect consolidated net operating revenues in the range of $21.15 billion to $21.35 billion, an increase of $150 million over prior expectations. As Saum mentioned, we are raising our 2025 adjusted EBITDA outlook range by $50 million at the midpoint to $4.47 billion to $4.57 billion, reflecting our outperformance in the hospital business. This is in addition to the substantial $395 million guidance raise that we announced in the second quarter. At the midpoint of our range, we now expect our full year 2025 adjusted EBITDA to grow 13% over 2024. Turning to our cash flows for 2025. We now expect free cash flows in the range of $2.275 billion to $2.525 billion, distributions to noncontrolling interest in the range of $780 million to $830 million, resulting in free cash flow after NCI in the range of $1.495 billion to $1.695 billion, an increase of $250 million at the midpoint from our previous guidance range. This reflects our focus on strong free cash flow conversion from our EBITDA growth, the continued outstanding cash collection performance of Conifer and continued investment into high-priority areas of our business. Now turning to our capital deployment priorities. We are well positioned to create value for shareholders through the effective deployment of free cash flow, and our priorities have not changed. First, we will continue to prioritize capital investments to grow USPI through M&A. 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 will evaluate opportunities to retire and/or refinance debt. And finally, we'll continue to have a balanced approach to share repurchases depending on market conditions and other investment opportunities. We continue to deliver consistent growth and have disciplined operations, which has translated into outstanding financial results. We are confident in our ability to deliver on our increased outlook for 2025 as we continue to provide high-quality care for our patients. And with that, we're ready to begin the Q&A.

Operator, Operator

Our first question comes from Kevin Fischbeck with Bank of America.

Kevin Fischbeck, Analyst

I wanted to ask you about the Q4 guidance and kind of the expectations for utilization. Are you guys building anything in there for higher utilization before these subsidies expire? And how do you think about the capacity, I guess, particularly within USPI to accommodate utilization there? And then I guess, secondly, you mentioned that USPI is insulated from the headwinds for next year, but just trying to understand a little bit where you do see that pressure. I guess can you talk a little bit about exchange exposure within USPI?

Saum Sutaria, CEO

There's a lot of questions to address here, so let me take them one at a time. First, we are not seeing any rush back to the office regarding the exchange subsidies and are not anticipating their expiration at this time. Based on our insights from Washington, it seems a compromise may take some time, but we’re patiently waiting for developments. Regarding capacity utilization at USPI, we typically see increased activity in late November and December, and we have already planned for the staffing and capacity adjustments that come with that every year. In short, we are confident in our ability to meet the demand usually seen at the end of the fourth quarter. We start planning months in advance with a well-established process in place, and there should be no significant changes to that this year, even if demand were to rise due to potential changes in the exchanges. Concerning the exchange business at USPI, it's important to note that the exposure on a per case or revenue basis is significantly lower than in the hospital segment. This is largely because newer exchange members tend to have consumption patterns similar to Medicaid, which accounts for some of the differences. Sun, do you want to add anything?

Sun Park, CFO

Yes, just a couple of metrics. Thank you. Kevin, I would also note for USPI that our implied Q4 guidance indicates an increase of about $80 million from Q3 to Q4, which is fairly standard when looking at our historical trends into Q4. We remain confident in both our capacity and our ability to care for those patients. Regarding exchange, in Q3, exchange made up 8.4% of our total admissions and 7% of our total consolidated revenues. This represents a slight increase in the percentage of admissions from Q2 and is relatively flat in terms of total consolidated revenue. We are seeing continued strong performance in the exchange segment, but there wasn't a significant increase in Q3. We'll see how it develops in Q4.

Operator, Operator

Our next question comes from Scott Fidel with Goldman Sachs.

Scott Fidel, Analyst

I wanted to hopefully just drill a little bit more to the CapEx inputs for the year, including the increase in the CapEx guidance. Maybe if you can talk about specific allocation of capital related to the increase and then maybe bucket some of the key larger investments that you're making within the CapEx for the full year.

Saum Sutaria, CEO

Yes. Scott, I appreciate the question. So I would just characterize the increased capital expenditure as more investment in both program or clinical program infrastructure, service line support, and various other growth strategies in the hospitals. I mean, obviously, our CapEx plan for the year included the residual capital that was required to open up the Port St. Lucie Hospital. So this is capital expenditure that has extended above and beyond that where we see opportunities for growth. Look, as I indicated, the demand environment continues to be very healthy, and we see opportunities and the efficiency with which we operate, our focus on service levels to the physician community, we see the opportunity for them to choose our sites as a location of care for their patients more and more. Obviously, the way in which we tend to deploy this capital is focused more on our high acuity strategy, so things that are relevant to the cardiac care unit, intensive care unit, cath labs, high-end imaging, et cetera, surgical programs. But that's really how we're making the investments around the country. And as we reviewed them through this business planning cycle, we felt it was a good time given the demand that we continue to see through the third quarter to go ahead and make those investments and raise our guidance.

Operator, Operator

Our next question comes from Craig Hettenbach with Morgan Stanley.

Craig Hettenbach, Analyst

Yes, I want to just extend that just focus on free cash flow here, the increase to guidance. You mentioned kind of improved cash collections at Conifer, you also have margins coming up. So any other context around kind of free cash flow and importantly, just the sustainability of those trends as you see it?

Saum Sutaria, CEO

Sun, go ahead.

Sun Park, CFO

Craig, thanks. Yes, as mentioned, this has been a long-term focus of ours, making sure not only EBITDA growth and EBITDA margins come through strong operational performance, but also then making sure that converts through free cash flow. And we listed some of the key drivers there. Obviously, the continued improving and fantastic performance by Conifer on cash collections. Obviously, growth in EBITDA comes through. And then probably a couple of other things that I'll point out. More broadly in terms of working capital management, we have spent a lot of time and focus on making sure we're optimizing all components of there. And then obviously, one of the additional benefits of our continued deleveraging is improvement in interest expenses, which also helps our free cash flow generation. We believe these operational efficiencies that we've implemented similar to our margin performance, whether it's Conifer or working capital management or continued EBITDA generation, we obviously will work hard to make these sustainable over a long period of time.

Operator, Operator

Our next question comes from Jason Cassorla with Guggenheim Securities.

Jason Cassorla, Analyst

Great. I just wanted to go back to your commentary around the implied Q4 guidance on USPI. At the midpoint, it would imply year-over-year growth a little over 8%, which is still strong, marks a little bit of a deceleration from like the low to mid-teens you've done this year. Just any thoughts around that? Is it conservatism? Anything from a timing perspective, like the pace of development coming online that's impacting that? Just any further detail around the implied fourth quarter guidance for USPI would be helpful.

Saum Sutaria, CEO

Well, Sun, let me start by saying that our comments regarding the organic performance of the business demand remain unchanged. We have certain assets at a larger scale and various pricing elements that are beginning to compare year-over-year. So, it's essentially just a matter of math. However, there are no changes; we are not approaching this fourth quarter at USPI any differently than previous fourth quarters. As I mentioned, our focus is primarily on the usual ramp-up of business that we typically experience. Sun?

Sun Park, CFO

Yes, I don't think I have anything further to add, Saum, thanks.

Operator, Operator

Our next question comes from Ann Hynes with Mizuho.

Ann Hynes, Analyst

Margins and cash flows have been strong, and costs have been managed well. Looking ahead to 2026, particularly regarding the labor environment, I believe it will perform better than anticipated in 2025. Do you think this trend will continue into 2026 in terms of labor? Additionally, are there any other inflationary pressures we should consider in our models? That would be helpful.

Saum Sutaria, CEO

Go ahead, Sun.

Sun Park, CFO

Sure. Ann, while we're not commenting specifically on '26 yet, we'll note a couple of things. You're right, our labor environment has generally been very strong and conducive to our operations, whether it's full-time labor expenses, whether it's our management of contract labor and other premium labor, whether it's pro fees. I think they've all been to our expectations. And in the current environment, as we sit here today, we don't see any meaningful changes coming. In terms of other inflationary pressures, again, not commenting specifically on '26. But obviously, the other topic that we've talked about is tariffs. We've said that for 2025, we've been able to manage that fairly well due to both our sourcing optimization exercises, whether it's contracting, whether it's working with our vendors, whether it's picking the right products as well as through efforts through our GPO. So we remain confident based on our contract structure that we have a couple more cycles where we'll be able to manage this. But obviously, as we get into the future years, we'll have to remain nimble on the tariff dynamic.

Operator, Operator

Our next question comes from Benjamin Rossi with JPMorgan Chase.

Benjamin Rossi, Analyst

I guess just checking in on Conifer. How did Conifer's contribution within the hospital operations segment shake out during 3Q? And then you've previously mentioned Conifer's ability to assist with patient eligibility and enrollment services during things like Medicaid redeterminations. I guess should the ACA exchange subsidies expire, do you think Conifer could have a similar utility for you in helping identify patients who have lost coverage and could be eligible for coverage elsewhere?

Saum Sutaria, CEO

That's a valuable observation regarding some of the capabilities we have in Conifer. I would also approach it from a different perspective. Given the current timeframe and the increasing likelihood of a compromise that we are hearing about, it is crucial that we have invested in the right capacity and capabilities to leverage Conifer's strengths in facilitating enrollment in both our markets and our clients' markets on the exchanges, especially if the enrollment timeline is delayed or extended. While we have the capabilities to assist with enrollment in other products, we are also enhancing our investments and strategies to manage what could be a disrupted enrollment timeline on the exchanges due to the potential for a later compromise. This approach will be beneficial in both aspects, and we are already increasing our staffing and field deployment in anticipation of that. Conifer is performing well according to our expectations within the segment, and we are pleased with its market performance for us and our clients, particularly from a cash collection perspective that I mentioned earlier.

Operator, Operator

Our next question comes from Ryan Langston with TD Cowen.

Ryan Langston, Analyst

Nice to see the ASC volumes positive. Any particular service lines or maybe even geographies driving this? And maybe same thing for the acute side, any hospital service lines stronger, weaker than you expected in the third quarter?

Saum Sutaria, CEO

Yes, I appreciate the question. At the beginning of the year, we indicated that we anticipated a pickup in the USPI environment later in the year based on how busy our physicians were. Looking closely at that, we noticed an increase in activity in the latter part of the year. The primary factor driving this growth, in addition to our investment in higher acuity services like orthopedics, spine, and robotics, has been strong performance in these areas. We observed a healthier GI recovery in the third quarter, aligning with our expectations based on physician volume in the first half. This recovery has significantly contributed to USPI volume. On the hospital side, as indicated by net revenue per case, that environment remains robust. Elements like trauma and high acuity emergency visits show less sensitivity to market conditions. However, I should point out that outpatient visits, which impact adjusted admissions, showed lower respiratory and infectious disease volumes than expected, potentially signaling a slower onset of the respiratory season. The data suggests this. Nonetheless, since we are discussing the third quarter, it's not likely a strong indicator for the future. The infectious disease and respiratory areas are the only aspects I would highlight regarding proportional performance.

Operator, Operator

Our next question comes from Justin Lake with Wolfe Research.

Justin Lake, Analyst

I might have missed it, but I was hoping to get an update on total contribution from DPP in provider taxes in the third quarter and your updated estimate on that benefit for the year. And then I appreciate you pointing out the $148 million of prior year DPP that we should think about as being kind of onetime, I assume. Any other items we should consider for 2026 in terms of that bridge year-over-year versus kind of typical growth?

Sun Park, CFO

Yes, Justin, in the third quarter, we recorded nearly $350 million, specifically $346 million, from supplemental Medicaid programs, with $38 million being from the previous year. This totals over $1 billion, specifically $1.02 billion, for the year to date in fiscal '25. Of that amount, $148 million was from out-of-period payments. I believe we're on track, falling right in line with our expectations once we account for the out-of-period prior year payments. Regarding normalizations, the $148 million from Medicaid supplemental payments is the most significant normalization factor for '25 into '26. Additionally, there are numerous other factors, as Saum mentioned in his opening remarks, related to reimbursement and other dynamics that we will need to consider as we provide further guidance in our next earnings call.

Operator, Operator

Our next question comes from Brian Tanquilut with Jefferies.

Brian Tanquilut, Analyst

Just a question on capital allocation. Obviously, you've set goals for USPI's acquisition spend and you've already exceeded that. And then how should we be thinking about that and then the buyback in terms of how you're thinking about throwing capital at the buyback since you've hit your M&A targets already?

Saum Sutaria, CEO

Yes. I mean, the M&A targets every year are obviously guidance that we go into the year with respect to expectations of what we're going to do. We're responsive to a marketplace, as you can imagine. And we're very careful about our diligence in maintaining our high bar for acquisitions. This year, we have found more opportunities, a broader pipeline, certain processes that may have been competitive in addition that we won and just continued momentum on our de novo strategy. So I mean, the kind of cash flow that USPI generates, we can fund those increases. Now obviously, if you go back historically, with the platform deals that we have done, we've also outspent our typical guidance. So look, we try to update that as we go quarter-to-quarter based upon what we're seeing in the environment and what we're bringing on board. Obviously, having these additional assets on board is positive for the organization going into the following year. And as I noted, we also continue to see some more opportunity in the fourth quarter. So we'll see how that all plays out. I mean we just remain focused on executing the M&A and de novo strategy. And if we do it with the appropriate diligence and onboarding, we're just updating what the spend looks like in the given year. Look, on the second point, we've been very active repurchasers of our shares this year. I would continue to reiterate that our trading multiples, we're long-term active repurchasers of our shares. This quarter, obviously, was lower than the prior quarter. There's also a lot more uncertainty in the market. And we feel fine about what we've achieved this year in that regard.

Operator, Operator

Our next question comes from A.J. Rice with UBS.

A.J. Rice, Analyst

As you start to think about 2026, pulling budgeting together, et cetera, are there any particular areas on the expense management side? I know you've talked a little bit about some of the things you're seeing this year in labor, but whether it's labor supplies, other that are opportunities for incremental savings or programs to initiatives to move forward. And then obviously, there's a lot of discussion about AI, whether there's anything on AI that's worth calling out that you're focused on being able to deploy that?

Saum Sutaria, CEO

Over the past few months, we have been working on a business transformation initiative aimed at identifying opportunities and preparing for uncertainties in the marketplace. This includes a focus on all aspects of labor costs within the organization. As we've noted, we have made adjustments to our corporate structure due to previous asset divestitures. Our philosophy is to leverage advanced analytics and automation while utilizing our Global Business Center, which is experiencing significant growth this year. There are many opportunities in this area. Sun has already covered supplies, so I won't elaborate further. We are also actively investing in improvement initiatives to enhance efficiency and collections in Conifer, some of which we have mentioned earlier. We are comprehensively exploring these opportunities with the goal of uncovering both short-term and long-term options that will benefit the business.

Operator, Operator

Our next question comes from Josh Raskin with Nephron Research.

Josh Raskin, Analyst

Just first was a quick clarification, I think, on Kevin's question. Did you see the contribution from exchanges, the revenue contribution was less than the percentage of adjusted admissions? And then my real question, just sort of getting back to the M&A environment for the ASCs. There's been a couple more reports, media reports in terms of maybe a competitive landscape. And I'm just curious if that's been changing or if you're seeing anything on valuations yet. And as you speak to your conversations with physicians, maybe how they're evaluating opportunities in ASCs as well.

Saum Sutaria, CEO

I believe the earlier commentary in response to Kevin's question was simply highlighting that our exposure to exchanges in terms of volumes or revenue is lower in the USPI hospital business. Whether considering the volume of exchange patients or the revenue generated from them, the relative impact on our business is less significant than in the hospital sector. I hope that provides some clarity. Regarding the ASC opportunity, I would say it encompasses various aspects of the growth platform we've established at USPI. We are actively involved in new developments, primarily focused on high-end specialties and collaborations with proactive health system partners. This situation consists of two key elements. We have worked diligently with MSO organizations that are investing capital and expanding their operations, making us the preferred partner in the ASC space. This strategy has yielded positive results across different service lines, including GI, orthopedics, our initiatives in ophthalmology, and of course, our urology platform. Thus, there are numerous growth paths available. Additionally, we frequently discuss the acquisition market. In this arena, we've consistently been considered the partner of choice, which is a significant factor in our successful scaling. Regarding physicians, answering your inquiry about what they seek, they generally want a partner with a reliable history of consistent performance, growth capabilities, and the ability to successfully onboard new assets, often based on positive feedback from their peers. Many single specialty physicians are also looking for experienced partners who can assist them in diversifying their operations to grow their center into a multi-specialty facility. This is an area where USPI has excelled historically in managing larger multi-specialty centers, helping these physicians advance their investment maturity. Overall, as I assess the market, we remain in a favorable position for building and expanding within this segment, which reinforces our confidence to invest more than initially planned and anticipate a strong pipeline in 2026.

Sun Park, CFO

And this is Sun. Josh, just to give you the numbers again, what we said was for HICS, it represents 8.4% of our admissions in Q3 of '25 and 7% of our total consolidated revenues. So the admission stat is slightly higher than the revenue stat, and that's been consistent for us historically. Hopefully, that helps.

Operator, Operator

Our next question comes from Whit Mayo with Leerink Partners.

Whit Mayo, Analyst

Saum, CMS has this new Wiser model in fee-for-service Medicare that starts next year. Do you see any impact on prior auth or administrative work for USPI? I know it's only 6 states, but Texas is one of them and knee arthroscopy and certain implants, I think, are an area they're focused on. So just any thoughts or insight into how you're preparing for this?

Saum Sutaria, CEO

Yes, there is some movement in the pre-authorization space in fee-for-service Medicare. The Wiser program still has some uncertainty regarding the scope of services it will be implemented for. However, we have considered what will be required. There are three main aspects to it. First, we need to prepare documentation and understand the requirements for appropriate care. Second, we must ensure consistent compliance with those requirements. Third, we need to manage our scheduling operations to align with preauthorization being achieved. We are prepared for this. While we don’t discuss it much, we have a strong revenue cycle function within USPI that handles all necessary services. Overall, we feel confident about it. In any marketplace where these changes are introduced, there is an adjustment period, allowing physicians to adapt their mix in the centers, especially those with block time. Therefore, part of our strategy will also be to increase the commercial mix and collaborate with physicians to enhance their commercial offerings.

Operator, Operator

Our last question comes from Andrew Mok with Barclays Bank.

Thomas Walsh, Analyst

This is Thomas Walsh on for Andrew. As we await the finalization of the hospital outpatient rule, could you comment on whether the removal of the inpatient-only list is a net positive or net negative for the enterprise?

Saum Sutaria, CEO

Okay. So that came through really garbled. I think the question was, is the inpatient-only rule list going away? And is that a benefit to us? I don't know that it's going away. I think there's been discussion about the inpatient-only rule list and what that impact would be. I mean, obviously, for us, the benefit would be in the USPI segment and potentially a push for more in certain types of volumes that have been in the hospital setting into the outpatient setting. In our acute care hospital segment, because of our greater focus on high acuity work, proportionally, and it's not to say that we don't have the business, but proportionally, those cases wouldn't be affected as much as maybe a typical general acute care facility. But we haven't done any quantification of that, that we've shared anywhere. I think this policy is still very much up in the air being discussed and not even at the point where I would say that we're engaging in rule-making discussions about it.

Operator, Operator

We have reached the end of the question-and-answer session, and this concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.

Saum Sutaria, CEO

Thank you.